On-Site Request Form

Use this form to request on-site computer repair service. Our team is notified automatically that
you need help. Provide as much information as possible and a member of our team will contact
you shortly to set up an appointment. If you prefer to contact us in other ways or for general inquiries, etc.

Your Name (required):
Company:

Please enter atleast one phone number:

Home Phone Number:
Mobile Phone Number:
Work Phone Number:
Email Address:
Street Address/PO Box:
Apt/Suite No:
City:
Province:	Ontario
Postal Code:

Service requested/problem:

Device Type: ie. Laptop, PC, Tablet, etc

Computer/Device ID Number
If you have previously had your computer/device serviced with us, it may have a tag with an ID
number on it. Please enter it here if you have one.