Service Request Form
Is your computer throwing more tantrums than a toddler denied candy? Has your printer decided to become an abstract artist? Fear not! Fill out this super simple IT Service Request Form, and our tech wizards will swoop in to save the day. Just a few clicks and keystrokes, and you'll be back to surfing the digital waves in no time!
Your Name
*
First Name
Last Name
Company Name
Are you a business?
Client-ID
Don't worry if you don't have it! New Customers, you'll get one when you submit this form.
Are you the affected party? If not, who?
Yes
No
Affected Party Name
*
First Name
Last Name
Affected Party E-mail
*
Use your registered E-mail address if you have an active HillTown Tech Subscription.
Affected Party Contact Number
*
Your E-mail
*
Use your registered E-mail address if you have an active HillTown Tech Subscription.
Your Contact Number
*
Date issue started
*
-
Month
-
Day
Year
Date
Time issue started
Hour Minutes
AM
PM
AM/PM Option
What is the issue with?
*
Password Issue
Computer Hardware Issue
Phone Issue (cell or desk)
Printing Issue
Internet Access (cannot use web)
Wireless issue
MS Office Issue (Excel, Word, Outlook, etc)
Supplies issue (toner, battery, etc)
Starlink Installation
Starlink Service
Power, or suspected power outage
Camera System, or display
New User
Other
What's going on?
*
0/0
Please verify that you are human
*
Submit Form
Should be Empty: