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
INFORMATION AND FORMS ARE PROVIDED "AS IS" WITHOUT ANY EXPRESS OR IMPLIED WARRANTY OF ANY KIND
INCLUDING WARRANTIES OF MERCHANTABILITY, NONINFRINGEMENT OF INTELLECTUAL PROPERTY, OR FITNESS
FOR ANY PARTICULAR PURPOSE. IN NO EVENT SHALL DOCSTOC, INC., OR ITS AGENTS, OFFICERS, ATTORNEYS,
ETC., BE LIABLE FOR ANY DAMAGES WHATSOEVER (INCLUDING, WITHOUT LIMITATION, DAMAGES FOR LOSS OF
PROFITS, BUSINESS INTERRUPTION, LOSS OF INFORMATION) ARISING OUT OF THE USE OF OR INABILITY TO USE
THE MATERIALS, EVEN IF DOCST