Repair Request Form

NOTE: You should receive a copy of your submission via email.
(If you use GMAIL, it may be in your spam folder.)
MAXIMUM 2 PIECES OF EQUIPMENT

    (be sure to tick the box above)

    Required fields are labeled - (required)

    Your Name (required)

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

    Telephone (required)

    Phone Type (required)

    CellLandline/VOIP

     

    Street Address (required)

    City, State Zip (required)

    Where did you hear about us? (required)

    Other information about how you found us:

    Drop-off date/time requested (required) - Call for special appointment, if not selectable
    (appointment selected is tentative and will be confirmed via email)

    *Note: Choose date first, then choose time*

    Drop-off/Shipping (required)

    --- Equipment Information ---

    Equipment 1

    Make 1 (required)

    Model 1 (required)

    Serial 1

    Date of Purchase 1

    Date of Problem 1

    Date of Last Service 1

    Short description of problem 1: (required)

    Please be specific as possible, we use this info for the repair

    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:

    Please be specific as possible, we use this info for the repair

    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, CashApp, Checks, or Credit Cards
    Note: there will be a 3% surcharge for Credit Card payments to cover expenses

    You can pay the deposit in advance here: CashApp

    (required) I have read and accept the Terms and Conditions

    Simple Math Question (required)


    (be sure to tick the Cloudflare box at the top of the form)