Customer Service Request

Please complete this form to submit a request for furniture repair service from Smith Home Furnishings.

Is this an emergency?

Is this an emergency? Yes No

Is this a power base, lift chair, or hazardous electrical issue?
Customer Name: Customer Name: First Last
Customer ID:

Customer ID can be found at the top of the purchase receipt.
Customer Address: Customer Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Text Friendly Cell Phone: Text Friendly Cell Phone: - ### - ### ####

Our Office Manager will send updates and request more info via text message. This is the fastest and most efficient way to communicate with our store.
Customer Email:
Please list item(s) with issue.
If possible, also include brand name and model numbers:
Maximum of 10 words allowed. Currently Entered: 0 words.
Brand and model information can be found on the manufacturer label or the purchase receipt.
Estimated Date of Purchase: Estimated Date of Purchase: / MM / DD YYYY

Please enter the date on your purchase receipt. If unknown, please enter your best guess.
Please BRIEFLY explain the issue:
Maximum of 250 characters allowed. Currently Entered: 0 characters.
Please upload photos of the issue here, if applicable:

Attach Files

Including photos of the issue or damage will help us diagnose the issue faster. Please include BOTH up close photos AND a picture of the entire piece of furniture.
Initials of person filling out form:
Today's Date: Today's Date: / MM / DD YYYY