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Contractor Referral Form

Thank you for contacting Reliance® on behalf of your Customer.

Please fill out the fields in the form and click SUBMIT.

You will receive an email confirmation shortly afterwards with the Customer’s name.

The Customer will also receive an email confirmation with the details submitted in the form along with all the appointment details (if applicable).

If you do not receive the confirmation message within a few minutes, please check your junk/spam folder and add [email protected] to your Safe Senders List.

In the event that an appointment needs to be scheduled/rescheduled, a Reliance Team Member will contact the Customer directly through the contact information provided.

Call on Reliance™ for all your home comfort needs.