Service Request Form

Customer Service Intake - (SPAM Will be Immediately Deleted)

Describe all Computer repair and Office technology-related issues that you are experiencing.

"*" indicates required fields

Name*

First Last

Phone*

Email*

Enter Email Confirm Email

Is this a computer related problem?*

Yes

Computer Brand*

Windows Operating System*

If this is not a computer issue, .(e.g. WiFi, Internet, Printer, Outlook, etc) select OS of the computer you are using.

Computer/Office Technical Issues*

You may select multiple issues. Hold down (Ctrl) key then Select with Mouse.

The username you select to get in to your computer.

Are you having an email problem?*

Yes

Email Password*

Because you selected that this is an email issue, please enter your email password, so we can resolve the problem.

Describe Issue(s) or Work you would like Performed*

Phone

This field is for validation purposes and should be left unchanged.