PC Repair Form

First Name(Required)

Last Name(Required)

Phone(Required)

Address(Required)

Problem Description(Required)

Diagnostic Cost Estimate(Required)

Device Credentials(Required)

Received

Username, password, etc on a sticky note

Power Adapter(Required)

Received

Please make sure customer brings power adapter before checking in the computer.

Date(Required)

Information About Device(s)(Required)

Make

Model

Signature(Required)

Parts Used

Item Price

Software, hardware, etc.

Tech Assigned

Labor Performed

Accept Conditions

I agree to the terms and condtions

Total

Signature

PC Repair Status(Required)

In Progress

Complete