Service Request Form

Welcome to Bruni and Campisi's online service department.
If you have an emergency or need service ASAP Please Call (914) 946-5558 24 Hours a Day
On-line service requests are scheduled on the First Available Business Day. A Customer Service representative will call to confirm your requested Date & Time slot. Should the Requested Date & Time slot not be available they will offer the next closest appointment during our regular business hours.

Service Requested By:

First Name:
Last Name:
Select One: Homeowner
Business owner
Owner's authorized agent
Tenant
Company:
Street Address:
(Address where work will be performed)
City:
State:
Zip Code:
Telephone:
Other Phone:
Pager Number:
E-Mail:
Do you have a
Service Agreement?		 Yes   No

Brief description of service needed:

Date and time of service requested

Day
 Month
 Date
 Note: For evening, night or weekend work, please call (914) 946-5558.
An Emergency Dispatcher will return your call in minutes
Time Preference
 Note: Overtime rates may apply to after hours Service.

Payment & Available Discounts

Please select form of payment you plan to use. Payment is due upon completion of service. It is our every intention of doing the work at that time. A diagnostic fee may apply. Please read our warranty policy. Select the "Back" button to return to this form.

 

Let us know if you are eligible for any of the following discounts.

Form Submission

Please complete this form thoroughly. Then review all the information above for accuracy and click on "Submit Work Order" button. Select the "Clear Form" button to start over, if necessary.