Service Request

DMC, LLC Service Request Quote

First Name

Last Name

Address Line 1

Address Line 2

City

State

Zip Code

Email Address

Phone

Invoice Number

Brand/Item Name and Stock Number

Was this item delivered or picked up?

When you received this item was it assembled or unassembled?

Was This a Special Order Item?

Was This a Closeout or Clearance Item?

Please describe your problem with your furniture

Upload Any Pictures Here (req by manufacturer)

Purchase Date

Pick-up/Delivery Date

Date Submitted (Today's Date)