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Service Request Form

1Contact Info
2Device Info
3Availability Info

Schedule Service Request
Tell Us About Yourself
1) Type of Customer

Residential

Business
2) Service Requested

We come to you! – No Contact service available

Remote Support (internet required)
3) Contact Preference
Select All
Cell
Email
Text
4) Full Name*

5) Email

6) Phone
7) Address
Street Address City State ZIP Code

Tell Us About Your Device and Issues!
8) Type of System?
9) Type of Operating Systems

10) Tell Us About Your Computer | Brand of Computer
Other Brand

11) What Problem Are You Having?
Other Problem

12) What's The Problem?

Tell Us Your Availability
13) How Urgent is This?

Normal Service (1-2 days)

Same day +$40.00
14) Time Preference
Select All
9am-10am
10am-12pm
12pm-2pm
2pm-4pm
4pm-6pm
6pm-8pm
Note: After-hours service after 8pm on double the hourly rate.
15) Best Day for Dispatch
Select All
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
15) How did you hear about us?

Promo Code

Message
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Email
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Schedule Service Request
Tell Us About Yourself
1) Type of Customer
- Residential
- Business
2) Service Requested
- We come to you! – No Contact service available
- Remote Support (internet required)
3) Contact Preference
- Select All
- Cell
- Email
- Text
4) Full Name*
5) Email
6) Phone
7) Address
Street Address City State ZIP Code

Tell Us About Your Device and Issues!
8) Type of System?
9) Type of Operating Systems
10) Tell Us About Your Computer | Brand of Computer
Other Brand
11) What Problem Are You Having?
Other Problem
12) What's The Problem?

Tell Us Your Availability
13) How Urgent is This?
- Normal Service (1-2 days)
- Same day +$40.00
14) Time Preference
- Select All
- 9am-10am
- 10am-12pm
- 12pm-2pm
- 2pm-4pm
- 4pm-6pm
- 6pm-8pm
Note: After-hours service after 8pm on double the hourly rate.
15) Best Day for Dispatch
- Select All
- Sunday
- Monday
- Tuesday
- Wednesday
- Thursday
- Friday
- Saturday
15) How did you hear about us?
Promo Code
Message
CAPTCHA
Name
This field is for validation purposes and should be left unchanged.

Δ

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