Computer Service Repair Form

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									This form is used by computer service providers to gather information about the
customer, product, and computer repair services rendered. It allows for organized input
of details for both customers and store personnel. This form provides for the computer’s
model number, serial number, product number, and year purchased. Instructions are
included in this document and should be deleted before publication. This form is ideal
for small businesses or other entities that provide computer repair services to keep track
of customer transactions.
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                                 Computer Service Repair Form

                                      Customer Information

Name

Address

Phone                                                   Email




                                     Computer Information
(Instructions: Specify basic information about the computer.)
Model


Serial Number


Product Number


Year Purchased


Has your computer undergone repair within the past 3 weeks?
         No
         Yes
If yes, please specify where

For parts needing replacement:

        I want to be contacted before parts are replaced.
        I leave it all to the technician.




© Copyright 2011 Docstoc Inc.                                   2
                                           Computer Issues
(Instructions: Identify the issues encountered by marking the corresponding checkbox. If the
problem encountered is not included in the options, specify it in the Remarks/Others section.
Items may be modified and added as needed.)



Power-related                                           Keyboard
        No power                                                  Some keys not working
        Slow startup                                              All keys not working
        System crash
                                                        Printer
        Slow shutdown
                                                                  No printer power
Monitor                                                           Not printing
        No display                                                Not detected
        Blue screen
                                                        Speaker
        Black and white
                                                                  No sound
        Limited colors displayed
                                                                  Hazy sound
        Blurry or fuzzy image
                                                                  Not detected



Remarks/Others (please specify):




I verify that all the information provided above is true and correct.




SIGNATURE                                 PRINTED NAME                               DATE




© Copyright 2011 Docstoc Inc.                                                               3
                                           Parts Surrendered
                                (To be filled out by store personnel or technician)
(Instructions: Mark the corresponding checkbox of the computer parts surrendered for repair.
Add as many items as required.)




Technician’s Remarks


        Central Processing Unit                                     RAM
        Monitor                                                     Motherboard
        Keyboard                                                    Video Card
        Mouse                                                       Disk drives
        AC Adapter                                                  Power Supply
        Modem                                                       Case/Bag
        Speaker                                                     Others:
        Printer
        Scanner



                                              Service Details
Parts Repaired:




Parts Replaced:




TECHNICIAN'S SIGNATURE                     DATE




© Copyright 2011 Docstoc Inc.                                                         4

								
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