ON LINE REQUEST * QM LLC
First Time Customer * Accurate Data Form
RV OWNER * First & Last Name
SPOUSE - PARTNER * First & Last Name
If there is no spouse or partner, type an X
PHONE # of SPOUSE or PARTNER
If there is no alternate phone number, type an X
RVer STATUS * Are you a
Seasonal Snow Bird
Full Time RVer
Enter street address, city, state and zip code of your state of residency
YEAR and OEM of RV
OEM = Original Equip. Manufacturer Such as: Coachman, Newmar, Jayco, etc.
If unknown, type an X
If RV is NOT in a Resort, please provide a GPS address (Street-City-Zip)
SITE or LOT Number
If this does not apply - type X
COUNTY (For Tax Rate)
Other or Unknown
Friend or RVer
Another Mobile Service
Saw Work Van
Log Cabin Visibility
If you have a departure deadline or other specific scheduling needs, please list it in the next section "Repair Needs"
911 * Urgent
ASAP Non Urgent
B4 Certain Date
Group with Other Jobs
If multiple issues, please number them. Be specific. If leak, specify if roof, plumbing, slide out, etc. If awning, specify patio, slide out, window or door. If electrical or LP issue, provide specific details. If you have specific scheduling needs, make a note of it in this section.
WARRANTY or INSURANCE
Our warranty rates and policies are posted on our website. It is important that you read them and agree to them before your service ticket is scheduled.
Please select what type of warranty you have.
NO WRNTY or INSRNC
RATES & POLICIES
Trip Fees, Labor Rates, Parts Pre-Pay Policy, Return Trip Rate and Payment Policies are posted on our website.
It is important that you read and agree to these policies before your service ticket is scheduled. Please indicate how you were informed of our rates and policies.
Not Yet Informed
PAYMENT POLICY * & AGREEMENT
Each trip the technician makes to your RV is billable at time of service. To pay by cash or check, you must be present at time of service. To pay by E-Check there is a $4 bank fee. To pay by Debit or Credit Card, a 4% convenience fee is added. We have accounts with VENMO, PayPal & Cash App You will receive an ADOBE DOCUMENT that must be signed and returned before your service ticket will be scheduled. When you are contacted to confirm your scheduled appointment, we will take a credit card number or pay app ID. If you are not present at time of service, your card or pay account will be charged the amount due. If parts are needed to complete repairs, you will be contacted once the tech has researched part numbers and prices. All parts must be pre-paid before we place the order. Some parts are not returnable. If you cancel a job parts are ordered, there will be additional shipping fees and a restocking fee that is determined by the vender. Please check the box below to indicate you have read and agree to these terms.
YES - I AGREE
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