Service Request Service Request Form Name(Required) First Last Mailing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Secondary PhoneEmail(Required) Computer SpecificsComputer Info(Required)Model #Serial #Login Password / Pin Add RemoveWhen Did the Issue Start?(Required) MM slash DD slash YYYY Would you Like a Data Backup?(Required) Yes No Description of the issue(Required)Disclaimer I agree to this disclaimerTeamViewer is installed on all machines unless specified not to be. TeamViewer is how we can help you remotely on future issues on your computer from our shop securely. If you wish to not have it installed, please let us know and it can be removed at any time. We will not be able to assist future repairs remotely if this happens. Machines would have to be brought into my office or schedule an on-site repair for future repairs. Data on your machine: Data loss is in no way the fault of Ctrl Alt Repair when the computer is brought in for a repair. We do not delete data intentionally but failing hardware / software corruption can happen and Ctrl Alt Repair is not responsible for any misplaced or data lost on any type of device. It is the customers responsibility to ensure data is backed up and safe prior to brining the machine in for repair. Abandoned Units: Delaware Code, Title 25, § 4001, in fact, provides that “tangible personal property which the rightful owner has left in the care or custody of another person and has failed to maintain, pay for the storage of, exercise dominion or control over, and has failed to otherwise assert or declare the ownership rights to the tangible personal property for a period of 1 year” shall be deemed “abandoned personal property.” CTRL ALT REPAIR WILL dispose of any units if left in the shop for 1 year or more with or without notice.Signature(Required)Entry Date(Required)
