New Customer Registration Form
Customer Details:
Full Name
*
First Name
Last Name
Address (For On-Site Visit only)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
E-mail
*
example@example.com
How did you hear about us?
*
Please Select
Website
Friend referal
Other
Friend or Referral Name?
What type of computer do you have?
*
Please Select
Windows 11 PC
Current MAC
Older PC with outdated Operating System
Older MAC with outdated Operating System
How much RAM does your computer have?
*
Please Select
4 gigs
8 gigs
16 gigs
More
How would you like to be contacted for your remote session?
*
Please Select
Phone
Text
Remote session chat
Tell us about your computer issue:
*
Let us know when to contact you
I confirm that payment has already been submitted for this support request.
*
Please Select
Yes
Please verify that you are human
*
Submit
Should be Empty: