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 computerâ€™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.
[PLACE LOGO HERE]
Computer Service Repair Form
(Instructions: Specify basic information about the computer.)
Has your computer undergone repair within the past 3 weeks?
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.
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(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.)
No power Some keys not working
Slow startup All keys not working
No printer power
Monitor Not printing
No display Not detected
Black and white
Limited colors displayed
Blurry or fuzzy image
Remarks/Others (please specify):
I verify that all the information provided above is true and correct.
SIGNATURE PRINTED NAME DATE
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(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.)
Central Processing Unit RAM
Keyboard Video Card
Mouse Disk drives
AC Adapter Power Supply
TECHNICIAN'S SIGNATURE DATE
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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 DOCSTOC HAS BE