Border Electrical & Refrigeration Service Contact Us Form

	Electrical and Refrigeration Service ..... helping maintain your ideal home / business environment.
	Factory 2 - 7 Mitchell Street, ECHUCA VIC 3564 Ph: (03) 5482 1966 Fax: (03) 5482 5585

This form should be completed for all general enquiries, to raise a service request, or to request information or status regarding an existing work request / Job Number.

* Required fields
Your Name:*
Business Name: ( where appropriate)
Site Address:

City:

State:

Postcode:

Your Phone:*

Mobile:

Email Address:*

Please select one of the following enquiry Subject options:

	This is a general information enquiry.
	This is a new request for service / assistance.
	This is a request for information / status for an existing job.

Existing job number provided to you: -