Service Ticket

IMPORTANT INFORMATION CONCERNING WARRANTY REPAIRS

The warranty does not cover the following:

REPAIRS NOT COVERED BY THE MANUFACTURERS WARRANTY ARE SUBJECT TO A NON-REFUNDABLE DIAGNOSTIC FEE.

Customer Information

Customer Name: *
Company Name:
Shipping Address: *
Shipping Address2:
Shipping City: *
Shipping State: *
Shipping ZIP: *
Email: *
Phone: *
Fax:

Billing Information (If different than above)

Billing Name:
Billing Company:
Billing Address:
Billing Address2:
Billing City:
Billing State:
Billing ZIP:
Billing Email:
Billing Phone:

Computer Information

Type of Computer: *
Manufacturer: *
Other:
Serial Number: *
Model Number: *
Part/Type/
Product Number:
*
Accessories:
DVD FLOPPY CD-ROM
MODEM CDRW AC ADAPTER
HARD DRIVE    
OTHER:
Symptoms:

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