Contact Information

Full Name *

Phone *

Email *

Existing Client

Has your family received services from Ethaar before? *

YesNo, this is my first time

About You

Home Address *

Needed for delivery scheduling.

Street Address

Apt / Unit

City

State

ZIP Code

Washer & Dryer Details

What type of washer/dryer connection do you have? *

Side-by-side (placed next to each other)Stackable (dryer stacked on top of washer)I don't currently have one

Are you requesting a new set or a replacement? *

New set (first time)Replacement

Delivery Acknowledgments

Will you be present at the scheduled delivery time? *

YesNo

If delivery fails due to your absence, you will cover the next delivery fee. Do you understand? *

Yes, I understandNo

Special delivery instructions

optional

Photo ID

Upload a Photo ID

Any government-issued photo ID. PDF, JPG, or PNG — max 5MB.

Submission Agreement

The following legal text is provided in English only for accuracy and will not be translated.

By submitting this form, I acknowledge that I have read and understand the guidelines set by Ethaar for receiving a washer and dryer set. I confirm that the information provided is accurate and truthful. *