Customer Order Form
Please provide the following information. It will be used to set up your account with us. You won't be charged anything for filling this out, we will contact you and help you pick the right services. We will charge after we have finished the service you ordered.
Personal Information:
First Name Last Name Date of Birth Home Phone Cell Phone Work Phone Street Address Address (cont.) City State/Province Zip/Postal Code Country E-mail FAX Organization Website
How did you hear about us?
Web Flyer Word of Mouth Referral Other:
Do you have High Speed Internet at your location?
Yes No
Preferred Technician:
Have you done business with us before?
Special Comments or Requests:
PC Issue: (Be as descriptive as you can. Tell us the Brand, Model, and Operating System of your machine. When the issue happens and what programs you are running at the time. Let us know if you made any recent changes to your computer, if you have security software installed and if the subscription for it is active.)
My PC issue is...
Service(s) Requested:
Product Name Standard Set Up Plan Premium Set Up Plan Professional Set Up Plan PC Check Up Hardware Installation and Setup PC Hard Drive/Optical Drive Installation
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