Service / Sales / Supplies Form
Please select ONSITE SERVICE or SHOP SERVICE:
*
On-Site Service
Shop Service / Carry In Service
Order Supplies
Sales Call
UID
PLEASE NOTE, SHOP SERVICE has a $35 Diagnostic Fee that will be applied to your total cost if approved. (Non-Refundable)
Company Name (Optional)
Preferred Hours of Service
Name
*
First Name
Last Name
Mobile: (Please note this is not for solictations. You will only receive text messages related to this service call
*
Please enter a valid phone number.
Email:
*
example@example.com
Equipment:
Copier / MFP
Printer / Fax
Computer
Laptop
Shredder
Other
PC / Laptop Password:
*
Make & Model
*
Problem Reported
*
Brief description of the problem you are having with equipment
Supplies Needed
*
Brief description of supplies needed
Sales Request
*
Brief description of reason of sales call
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
If convenient, please take a photo of equipment.
My Products
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$35.00 Diagnostic Charge
Non-Refundable Diagnostic Charge
$
35.00
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
ACH Bank Transfer
Submit
Should be Empty: