Jaks Computer - Repair Service Form

Jaks Computer - Repair Service Form

Please provide your contact details and computer information for repair. Note: No parts will be ordered without your permission.
Contact Person Full Name*

First NameLast Name
Contact Address*

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Contact Email Address*
example@example.com
Contact Phone Number*
Please enter a valid phone number.
Date Received (to be completed by repair center)

MonthDayYear
Date
Date Completed and Sent (to be completed by repair center)

MonthDayYear
Date
Computer Model*
Computer Serial Number*
Operating System Version*
Processor, RAM, and Hard Drive Details*
Technician Notes
Problems Identified*
Solutions Provided
Date and Time of Repair Appointment
Type of Problem*
Other Notes*
I understand that no parts will be ordered without my permission.*
Authorized Signature (to be completed by repair center)*

First NameLast Name
Date of Signature*

MonthDayYear
Date
Should be Empty: