A-Home Electronics In Home Service Call Request 207B 20th St N Jacksonville Beach, FL 32250 (located across from Adventure Landing on Beach Blvd, behind Hoyt Stereo) In Home Service Calls are $49.95 - $69.95 based on your zip code. The In Home Service Call fee is applied towards your repairs cost of the corresponding unit with the exception of insurance estimates and replacement lamps / bulbs.
Your Contact & Service Call Information
Name*	First Last
Address*	Street Address Address Line 2 City State / Province / Region
Your Zip Code*	Select 32003 ($69.95) 32043 ($69.95) 32065 ($69.95) 32073 ($69.95) 32081 ($49.95) 32082 ($49.95) 32092 ($69.95) 32202 ($69.95) 32204 ($69.95) 32205 ($69.95) 32206 ($69.95) 32207 ($49.95) 32208 ($69.95) 32209 ($69.95) 32210 ($69.95) 32211 ($49.95) 32216 ($49.95) 32217 ($49.95) 32218 ($69.95) 32219 ($69.95) 32220 ($69.95) 32221 ($69.95) 32222 ($69.95) 32223 ($49.95) 32224 ($49.95) 32225 ($49.95) 32226 ($49.95) 32233 ($49.95) 32244 ($69.95) 32246 ($49.95) 32250 ($49.95) 32254 ($69.95) 32256 ($49.95) 32257 ($49.95) 32258 ($49.95) 32259 ($49.95) 32266 ($49.95) 32277 ($49.95)
Phone Number*	### - ### - ####
Phone Number	### - ### - ####
In Home Service Call Date*	123456789101112 MM / 12345678910111213141516171819202122232425262728293031 DD / 2010 YYYY
Services Needing Rendered*	In Home Service Call ($49.95 - $69.95 depends on your zip code above)   Add'l TV / Component (add'l $20.00)   Add'l TV / Component (add'l $20.00)   Add'l TV / Component (add'l $20.00)   Replacement Lamp / Bulb (add'l $190.00 - $265.00 + Tax)   Insurance Estimate Service Call   Add'l TV / Component for Insurance Service Call (add'l $39.50)   Add'l TV / Component for Insurance Service Call (add'l $39.50)   Add'l TV / Component for Insurance Service Call (add'l $39.50)   In Home Hook Ups (add'l $69.50 per hour)
TV / Component Information
TV / Component #1 Make / Model*
TV / Component #1*	ProblemLightning / SurgeNo SoundNo PictureShuts OffLinesPicture DistortedButtons Broken3D ImageScreen BrokenReplacement Lamp / BulbRF / Cable Connector BrokenOther
TV / Component #2 Make / Model
TV / Component #2	ProblemLightning / SurgeNo SoundNo PictureShuts OffLinesPicture DistortedButtons Broken3D ImageScreen BrokenReplacement Lamp / BulbRF / Cable Connector BrokenOther
TV / Component #3 Make / Model
TV / Component #3	ProblemLightning / SurgeNo SoundNo PictureShuts OffLinesPicture DistortedButtons Broken3D ImageScreen BrokenReplacement Lamp / BulbRF / Cable Connector BrokenOther
TV / Component #4 Make / Model
TV / Component #4	ProblemLightning / SurgeNo SoundNo PictureShuts OffLinesPicture DistortedButtons Broken3D ImageScreen BrokenReplacement Lamp / BulbRF / Cable Connector BrokenOther
Insurance Contact Information If you have an insurance affidavit, please fax it to us before the service call appointment at 904-242-0040 to expedite your insurance claim.
Attention To Name	First Last
Email for Insurance Estimate
Insurance Company Fax Number	### - ### - ####
How did you hear about us?*	SelectGooglea-homeelectonics.comFriend / RelativePrevious CustomerATT - Yellow PagesLocal Edge - Yellow Pages