Electronics Repair Form

Attention:
Due to the bridge collapse in Baltimore, parts shipments may be delayed.
NOTE: You should receive a copy of your submission via email.
(If you use GMAIL, it may be in your spam folder.)

    Your Name (required)

    Your Email (required) - If you use GMAIL, check your spam folder

    Telephone (required)

    Street Address

    City, State Zip

    Where did you hear about us? (required)

    If Other:

    Drop-off date/time requested (required)

    Drop-off location requested (required)

    --- Equipment Information ---

    Equipment 1

    Make 1

    Model 1

    Serial 1

    Date of Purchase 1

    Date of Problem 1

    Date of Last Service 1

    Short description of problem 1:

    Equipment 2

    Make 2

    Model 2

    Serial 2

    Date of Purchase 2

    Date of Problem 2

    Date of Last Service 2

    Short description of problem 2:

    Equipment 3

    Make 3

    Model 3

    Serial 3

    Date of Purchase 3

    Date of Problem 3

    Date of Last Service 3

    Short description of problem 3:

    A deposit fee of $60.00 is paid upon dropping off or mailing in equipment.

    The final repair bill will deduct the deposit fee.

    We accept Cash, Check, or CashApp

    You can pay the deposit in advance here: CashApp

    I have read and accept the Terms and Conditions

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    Enter Security Code

    Simple Math Question