Request Appointment

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Request Appointment

To request an appointment with a Cocalico Service Technician or a System Estimator, use our easy online form.

PLEASE NOTE that this is a request form only. This does not create a formal appointment.

A Cocalico representative will contact you shortly to schedule an appointment using the information you've provided.

To speak to a customer service representative call: 717.738.0760 (Lancaster County) or 717.949.2719 (Lebanon County).

Type of Request:*

Customer Information

First Name:*

Last Name:*

Email Address:*

Phone:*

Service Information

Service Address 1:*

Service Address 2:

Service City:*

Zip:*

Requested Time Slot

Request Service Date:*

Calendar

Appointment 1:

8am - 10am

Appointment 2:

10am - 12noon

Appointment 3:

12noon -2pm

Appointment 4:

2pm - 4pm

Additional Information

Status:

I am an existing Cocalico customer.
I was referred to Cocalico by an existing customer.
I am a new customer.

Comments:

Confirmation:*

I understand that this is a service request only, and that this does not create a formal appointment with an Cocalico representative. After submitting this request, I will receive a phone call from Cocalico to schedule an appointment on the times I have submitted as a guideline.

* required