Request for Service

Please fill in the form and it will be reviewed as soon as possible.

Request for Service

Name of Company :
(Required)

Name of person requesting/authorizing service call :
(Required)

Name of jobsite contact (if different from above) :

Phone Number :

Email Address :
(Required)

Company Information

Our Company (select one) :

Requires purchase orders to be issued for service.
Our purchase order number is :
Does not require purchase orders to be issued for service.

Our Company is (select one) :
An existing customer of Helix Mechanical Services
A contract customer. (Note: Contract customers receive priority service.)
A new customer.
(Please contact us with information on how we can set up a service account with Helix Mechanical Services)

Type of Call : (Required)

Location Where Service Is Requested

Address :
(Required)

City :
(Required)

State :
(Required)

Zip Code :
(Required)

Unit Information

Type of unit :

Unit number (if applicable) :

Unit location :

Unit model (if known) :

Unit serial (if known) :

Detailed description of problem :