Customer Info
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Services
*
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( X )
Assessment of device (In Office)
Assessment of device to determine issue and solution for repair.
$
47.00
Onsite Service
Going on-site to customers' locations for service
$
170.00
Quantity
1
2
3
4
5
6
7
8
9
10
Pickup Service
Picking up the device for repair and returning.
$
85.00
Quantity
1
2
3
4
5
6
7
8
9
10
Credit Card
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