New Computer Repair Job Form
Customer Details:
Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
E-mail
*
example@example.com
Please explain where possible what the issue with computer is:
*
What day suits you for pickup?
*
Please send a clear image of the issue if possible:
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Do you agree to the terms and conditions? These can be found on the website - http://www.globalpcfixers.com
*
Please Select
Yes
No
Submit
Should be Empty: