Name
Phone
Mobile
*
Your Company
Email
*
Address
*
Street
City
*
Post Code
*
Type of Service
Onsite Visit
Collection & Delivery
Send Your Computer By Courier
Drop Off in Workshop
Type of Computer
Desktop
Laptop
Small Business Network
Broadband + Wireless
General Computer Maintenance
Other
Operating System
Windows Vista/7
Windows XP
Windows 2000-03-08
Apple Mac
Linux/Unix/Solaris
Windows 98/ME
Not Sure
Age of the Computer
Less than a year
Less than 2 years
Less than 3 years
More than 3 years
Not Sure
Type of Internet Access
Broadband
DSL + Cable
Wireless
Modem Dialup
Network/Ethernet
Not Sure
Problem Summary (Briefly explain waht the problem is or what you want to get done:)
*
Date You Require the Service
*
-
Day
-
Month
Year
How Did You Hear About Us
Google
Yahoo
Friend or Word of Mouth
Online Directory
MSN
Other
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