Full Name:
Email Address:
Service Address:
City:
State:
Zip Code:
Phone Number:
Time Frame:
Select Time frame
1-2 Bussiness Days
3-4 Bussiness Days
4-5 Bussiness Days
Are you an existing Client?
Yes
No
Please check all the symptoms that apply:
Will not turn on (no lights)
Will not boot but will turn on
Freezing / Locking up
Errors / Blue screen
Operating slower than normal
Multiple pop-up's / Browser hijacks
Virus that cannot be removed or quarantined
New noises such as clicks, whines, grinding, etc.
Strange or erratic behavior
Use the space below to give us more specific information about the problems you are having.
Computer Manufacturer:
Select Computer Manufacturer
ACER
COMPAQ
DELL
GATEWAY
HEWLETT PACKARD
SONY
TOSHIBA
CUSTOM BUILT
Computer Type:
Desktop
Laptop
Server
Other
What O/S are you running:
Select O/S Version
WINDOWS 95
WINDOWS 98
WINDOWS 98 (Se)
WINDOWS ME
WINDOWS 2000
WINDOWS XP (Home)
WINDOWS XP (Pro)
OTHER
Anti-Virus:
Select Type of Anti-Virus
Norton
McAfee
Other
None
Anti-Virus Status:
Up-to-date
Trial Ver.
Expired or Unknown
Login Name / Password (if any):
Data Backed up:
SELECT ONE
I have backed up my data.
I have not and do not want it backed up.
I would like my data backed up.
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