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PC Repair Form



Computer Repair Form Template



PC Repair


Date of Request: ____/____/_____

Requesting Party:

_________________________

General Description of Computer Problem:

_________________________

_________________________

_________________________

_________________________

_________________________

Computer Information:

Make: ___________________

Model: __________________

Operating System:

_________________________

Is the computer under warranty:

[__] Yes [__] No

Contact Information:

Name: __________________________

Address: _______________________

Phone: _________________________

Email: _________________________

Payment Method:

[__] Cash

[__] Credit Card

Amount Due: $__________________


________________________________
Customer Signature





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