PC Repair Request

Full Name

Phone Number

Email Address

Preferred Contact Method

Phone

Email

Text/SMS

Device Type

Brand/Manufacturer

e.g., Dell, HP, ASUS, Custom Build, etc.

Model

If known

Age of Device

Operating System

What problems are you experiencing?

Select all that apply

If “Other issue” selected, please describe

Detailed Problem Description

Please describe what happens, when it started, any error messages, etc.

When did the problem start?

Have you tried any troubleshooting steps?

e.g., restarting, running antivirus, checking cables, etc.

Urgency Level

Budget Considerations

Data Backup Status

I have recent backups

I have some backups but not recent

I have no backups – please help preserve data

Data loss is not a concern

Additional Information

Any other details that might be helpful