Antique Gas Stoves

6371 Haven Avenue Ste 3

Rancho Cucamonga , CA 91737

(909) 484-2222

NAME_____________________________________________________

ADDRESS__________________________________________________

CITY__________________________STATE________ZIP___________

TELEPHONE________________________________________________

EMAIL ADDRESS____________________________________________

Please Indicate

NATURAL GAS USE

LP USE

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Check what parts or part you are sending and quantities:

Oven thermostat (Please include knob)

Safety valve(s) (Please include thermocouple)

Clock

Timer

Burner valve(s)

Other

Name Brand of stove________________________________________________________________________________________

Description of problem with stove and or part______________________________________________________________________________________________________

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