HOME EQUIPMENT WORK ORDER FORM

Please read Billing Policies and Procedures, then completely fill out form and click ‘submit’. Please note, all fields are required before submitting form. Thank you!

Service Rates and Billing Procedures

Operating Hours:

Monday - Thursday, 8:30am - 4:30pm

Standard Service Rates - 2025:

All home equipment repairs are performed at the Harmony shop. Drop-off is required.
A non-refundable $100 diagnostic fee is due at the time of drop-off.
Repairs are then billed at $130 per hour, with a one-hour minimum, and charged in 15-minute increments thereafter.
Payment for labor and parts is due at the time of pickup.
If your machine is determined by Harmony to be non-repairable, you will only be responsible for the $100 diagnostic fee — no additional labor charges will apply.

Please note: Commercial clients are given scheduling priority over home repair clients. However, harmony is committed to timely service and will provide updates throughout the repair process.

Name

First Name

Last Name

Phone #

(###)

###

####

Preferred Contact Method

Billing Email

All Invoices are sent to this address

Message for Harmony

Manufacturer and Model of your Home Equipment

Not to Exceed Amount

Maximum cost of service call before needing authorization

Payment Method for Invoices

A 3% fee is added to all credit card transactions

Bank Transfer (ACH Payment)

Check, Mailed to HCS

Credit Card

I have read and agree to Harmony Coffee Service's Billing Policies & Procedures

I Agree

Do Not Agree

Signature

I am authorized to sign for service on behalf of the above company, and by writing my name in the field below I agree to Harmony Coffee Service Terms and Conditions.

First Name

Last Name

HOME EQUIPMENT WORK ORDER FORM

Service Rates and Billing Procedures

Operating Hours:

Monday - Thursday, 8:30am - 4:30pm

Standard Service Rates - 2025:

All home equipment repairs are performed at the Harmony shop. Drop-off is required.

A non-refundable $100 diagnostic fee is due at the time of drop-off.

Repairs are then billed at $130 per hour, with a one-hour minimum, and charged in 15-minute increments thereafter.

Payment for labor and parts is due at the time of pickup.

If your machine is determined by Harmony to be non-repairable, you will only be responsible for the $100 diagnostic fee — no additional labor charges will apply.

Please note: Commercial clients are given scheduling priority over home repair clients. However, harmony is committed to timely service and will provide updates throughout the repair process.