Submission form split version

source
Case type*
Choose what service you want.
Computer type*
What kind of computer?
Data recovery*
What kind of device do you want data recovered from?
Request type*
Request type determines the duration of the repair, if in doubt choose "Extended troubleshooting" it can always be changed when talking to employee.

Description of the problem
Please describe what the problem is.

Customer type
Choose wether to continue as a private or business customer
Which insurance company?*
Skadenummer*
Company Name*
Name of company
CVR*
Campany CVR
EAN
Bruger ID (udfyldes kun ved EAN hvis det er påkrævet!)
Name*
Enter first and last name
Phone*
Please enter phonenumber including country code
Email*
example@example.dk
Address*

Street

Street Address Line 2

CityState / Province

Zip code
Reffered from
Where did you hear about us?
Are you currently a student/retiree?

YesNo

Hand in*
How du you want to get the device to us
Location*
At what workshop do you want it repaired?
Expected hand in date*

DayMonthYear
Hand out*
How do you want to get back your device?
Should be Empty: