YOUR LOCAL COMPUTER REPAIR COMPANY, FOR LESS!
PH: 408-300-1311 or 408-510-9282


As easy as 1-2-3
Fill out the form and Submit it
Bring in your computer / Sign the Disclosure
Pick it up the same or the next day.


First Name:
Last Name:
Address:
City, State, Zip:
Home Phone:
Cell Phone:
Best Number to Call:
Problem Information
(Please fill out what you can or just leave blank)
Current Problem
(Please fill out what you can or just leave blank)
When did it start:
Recent Software /
Hardware Upgrades and/or Changes:
Recent New Hardware Additions:
 (Printer, Scanner, Camera, etc.)
History
 (did you have this problem before)
Past Repairs
 (where and approx. when)
What is your suspicion?
System Information
 (Please fill out what you can or just leave blank)
Computer Brand (Ex: Dell, HP):
Computer Model (Ex: Inspiron, Pavilion):
Current Operating System (Ex: Windows XP, Vista Home):
Serial Number (if any):
Part Number (if any):
Service Tag Number (if any):


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