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Call Center Lead Form Appliance Repair

Call Center Lead Form - Lowes - Appliance Repair

Great, let's get some information about your project.

What's your First and Last Name?

Verify spelling

What is the project Zip Code?

Can you confirm the Store that you shop in?

Select a different store if applicable.

Placeholder text...

Can I have your email?

If they object: We need your email so we can send updates and give you access to My Projects, your customer portal, where you can manage the project yourself.

What is the street address for the project?



Confirm City; Select a different City if needed.

Is your mailing address the same as the project address?

Can we have your Cell or Home number to confirm your appointment?


Is that your Cell or Home?

Do you have another number in case we can't reach you at your primary number?

We need a number other than Office so that the auto-dialer can leave a message.

And is that your cell, home or office?

Great, you'll receive confirmation of your appointment as soon as it is confirmed by the technician.

Do you have any questions before I submit your request?

Great, we look forward to helping you with your repair.