Computer Repair Intake Form

Ready to get your computer fixed? Please fill out the repair intake form below. Then dropping off your computer at DiverseIT will be fast and easy!

Questions?  Call 505.881.TECH (505.881.8324)

Name: ^*

Company:

Email: ^*

Phone: ^*

Let us know before you arrive at DiverseIT what needs to be fixed on your computer. Select options below. Thank you!

Power Issues

Does the computer show activity when plugged in and the power button is pressed?: ^* --Select--YesNo

Are there any lights on the computer when it is plugged in?: ^* --Select--YesNo

Video Issues

Can you see anything displayed on the screen, if even for a moment?: ^* --Select--YesNo

When the computer powered on, does the screen turn on?: ^* --Select--YesNo

Virus Scan

Does the computer behave in unexpected ways?: ^* --Select--YesNo

Do things happen without your input?: ^* --Select--YesNo

Password Reset

Do you need the windows password to be reset?: ^* --Select--YesNo

Data Save

If we have to rebuild the computer, do you have files to backup?: ^* --Select--YesNo

Internet

Can the computer connect to the internet?: ^* --Select--YesNo

Screen Issues

Is the screen cracked?: ^* --Select--YesNo

Does the computer show strange patterns?: ^* --Select--YesNo

Operating System Install

Would you like to have your operating system changed to a specific system?: ^* --Select--YesNo

Hardware Upgrade

Would you like to have your RAM, Hard Drive, Video Card, etc. upgraded?: ^* --Select--YesNo

General Cleaning

Would you like to have the device cleaned inside and out?: ^* --Select--YesNo

Best time to contact: ^*

If yes to any of the questions, please describe below.: ^*

By signing below, I acknowledge that I have read and accept the Personal Computer Repair Waiver included in this form.

Signature

Type the text shown: *

^* These fields are required.