Computer Service Agreement

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					                                                                                                        Computer Therapy, Inc
          Computer Service Agreement                                                                     105 Strawberry Patch
                Please complete all requested information (legibly)                                     Chapel Hill, NC 27516
                                                                                                           (919) 932-4357
            Name:
   Street Address:                                                                C                           Z
     Home Phone:                                           Work Phone
        Cell phone                                       Fax number
 Internet Provider:       TimeWarner Earthlink Verizon ATT/Bellsouth Embarq AOL NetZero Juno PeoplePC Other: _____________
   E-mail Address                                           I use: Outlook - Outlook Express - Thunderbird - Webmail
    Username/PW                                                         How many user profiles are there? 1 2 3 4 5 6
Any password required to access your computer at boot up? Y / N Other passwords for other user profiles? ____________________
Please indicate your Internet connection type:       DIAL-UP     CABLE        DSL         WIRELESS           SATELLITE
Is there a network at your location?                 YES          NO
What is the latest we can call in the evening? __________ AM / PM DISCOUNTS: SENIOR?                 VETERAN?      TEACHER?

Hardware and software items being submitted for service (include serial / model numbers)
DESKTOP COMPUTER - or - LAPTOP COMPUTER?                               -- Is BAG included?             YES / NO --          AC Adapter YES / NO
Manufacturer:                              Model #:                                   Serial #:                                Circle Windows version
Software:                                                              Other:                                          Win98 - ME - 2K – XP - Vista - OSX


Is there a valid warranty? NO YES (If so, from who? __________) If so, do you have the original purchase receipt? YES                                                  NO
Describe the specific problem to be addressed:




Describe any incidents prior to the problem: (include new software, hardware, suspicious downloads, power outages, manual reboots, etc)




Please indicate if you want to have us check for the issues listed below. Additional costs will be conditional based on the circumstances but you will
be notified in advance should your system need SPYWARE or ADWARE cleaning.

SPYWARE / ADWARE:                        □ YES check for these problems - □ NO I will take of these issues (if not marked assume you will take care of it)
BACKUP:        Would you like an estimate for us to back up your data to CD / DVD? Price will depend on data
quantity. If you indicate YES, we will contact you for the cost of the backup:
                      □ YES: DO BACKUP MY DATA                                    -     □         NO:I HAVE A CURRENT BACKUP
Our basic rate is $45/half-hour IN-SHOP OR $55/ half hour ON-SITE (plus travel and/or pick-up/delivery). A travel and/or pick-up/delivery charge will be added for on-
site and pickup/delivery. Please indicate the monetary limit we should adhere to prior to further approval. The standard minimum is one half hour (plus travel if / pickup if
appropriate). Any portion of a subsequent half hour is billable at the entire half hour rate. Every effort is made to minimize your cost but the technicians do not have the
authority to negotiate the pricing structure. The amount you authorize below should reflect any discussion you may have had with a technician prior to this service. If not
listed, we assume that we are authorized to solve the problem without regard to cost. We will of course consider the logical / reasonable costs but your limitation and
authorization as listed indicate your approval for service. Acceptable forms of payment are cash, personal or business check, Money Order or Paypal (fees may apply).

MONETARY LIMIT AUTHORIZED: $ ___________                                                                     or         # of hours __________
CUSTOMER CONSENT AGREEMENT:
I hereby authorize Computer Therapy to perform all work necessary to resolve the problem(s) as listed above. My signature below verifies that I either have a current back-up of
all data or that I have no data that must be backed up. In either case CT is not responsible for maintaining my data. (CT will make every effort to backup and save your data but
is not liable for data loss in any manner).

I understand that payment for all work is due at the time of delivery. Failure to do so WILL result in additional fees.               (initials required:____)
Authorized signature: _________________________ Date: ___________

SERVICE COMPLETED SATISFACTORILY:                                                                          □ Internet             □ E-mail               □ Printer
Authorized signature: _________________________ Date: ___________                                          □ Sound                □ AV                   □ Network
                                                                                                           □ Drives               □ software             □ disks rtn’d

				
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posted:9/12/2012
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