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Personal Information

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First Name

Last Name

Phone Number
1

Address

City

State

Zip

Appointment Information

Appointment Day -+

Appointment Time

Language Preferred

Service Information ( Parts or Components Not Included )

Computer Repair	DSL Installation	Windows Installation
Computer Maintenance	Peripheral Maintenance	Windows Upgrade
Data Recovery	Printer Installation	Virus Removal
Data Transfer	Scanner Installation

Hardware Installation
CD/DVD/Floppy Installation	Modem Installation	Sound Card Installation
Hardrive Installation	Network Card Installation	Processor Installation
Memory Installation	Power Supply Installation

Computer(s) Information

Number of Computers

Computer Brand

Serie

Year of Purchase

Other Brand

Type of Computer(s)

Operating System(s)

Other Operating System

Do you have the drivers (installation software) of your computer ?

If You don't have the Driver, Explain which ones you don't have
Modem/ Sound/ NIC/ Video. If is Possible give Brand and Serial Number

* PC Repair Please explain the problem with your computer

Comments / Questions

Estimated Cost >>Please Add Fee $ 25

Tax Included

Estimated in cost of services NO number of Computers

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