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Customer Repair Inquiry

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Service Request Form

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Name: *

Company:

Address: *

E-mail address: *

Telephone: *

Make:

Model:

SN:

Yes, there are user files on this unit that need to be saved. All user data will be backed up first in the event that software needs to be reinstalled. I understand that there may be an additional charge for this service.

No, there are no important user files that need to be saved on this unit. I understand that all user data may be lost if software needs to be reinstalled.

I understand that there is a $60 + tax non-refundable deposit toward any diagnosis or repair, which is due at the time of unit check in.

Issue/Problem: *

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I herby agree that my data entered in the contact form will be stored electronically, and will be processed and used for the purpose of establishing contact. I am aware that I can revoke my consent at any time.

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