Computer Service Agreement - PDF

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					Work Order #

            Computer Service Agreement                                                                    At Home PC Support
                                                                                                         Computer Therapy, Inc
                                                                                                          105 Strawberry Patch
                  Please complete all requested information (legibly)
                                                                                                         Chapel Hill, NC 27516
                                                                                                            (919) 932-4357
                                                                                                                        9am-6pm M-F
      Street Address:                                                           C                           Z
        Home Phone:                                      Work Phone
           Cell phone                                  Fax number
                        TimeWarner Earthlink Verizon ATT/Bellsouth Embarq AOL Dialup Juno
    Internet Provider: Time Warner CenturyLink Windstream Charter Connect NC NetZero Other: 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 Approximate ageSENIOR?
                                                                     DISCOUNTS: of PC(s):              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:                                                 XP - 2K XP - Vista
                                                                                                                        Win98 - ME Vista– Windows 7 - 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
                    $45/half-hour IN-SHOP and $5 less for each additional 1/2 travel and/or pick-up/delivery). A travel and/or pick-up/delivery charge will be added for on-
  Our basic rate is $40 for the first 1/2 hour OR $55/ half hour ON-SITE (plus hour for on site service, see the scale to the bottom right for addtional info and fees for off
  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 & / 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
                                                                                                                                                      or Credit apply).
  authorization as listed indicate your approval for service. Acceptable forms of payment are cash, personal or business check, Money Order or Paypal (fees maycard Via Paypal

  MONETARY LIMIT AUTHORIZED: $ ___________                                                                     or         # of hours __________
  I hereby authorize @ Home PC techs 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
                       Computer Therapy
  all data or that I have no data that must be backed up. In either case I willam responsible for maintaining my data. (CT will make every effort to backup and save your data but
                                                                         CTIis be
                                                                                not                                     We
  is not
 aren't 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 1/2$40 E-mail $30 $25
                                                                                                          Price scale    First
                                                                                                                                   □                      □
                                                                                                          Onsite labor                     $35
  Authorized signature: _________________________ Date: ___________                                         □
                                                                                                          Offisite labor
                                                                                                                 Sound             □
                                                                                                                                $35 AV    $30       $25   □ $20Network
                                                                                                          20$ Fuel fee will be charged for all trips of 20 miles or more
                                                                                                            □ Drives               □ software             □    disks rtn’d

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