PC REPAIR DROP-OFF FORM

Diagnostic & Repair Options *

Name *

First

Last

Address *

Address 1

Address

Address 2

City

State/Province

Phone Number *

Content Dropped Off *

Charger included? *

Windows Login Password & PIN *

Windows Password

Email Address *

Description Of Problem *

Computer Brand & Serial Number *

Customer agrees to the following terms: *

1. The installation & removal of software or hardware can sometimes result in the loss or corruption or data. I (customer) will not hold The Tech Monkey liable for any lost data.
2. The process of reinstalling the Operating System will likely result in the loss of saved Passwords, Browser Settings & other personalized options. Programs cannot be backed up
3.The Tech Monkey will charge a $69 diagnostic fee if you do not wish to proceed with repairs.

Date *

Signature (First & Last Name) *

PC DIAGNOSTIC & REPAIR DROP-OFF FORM