VistaTech Computers

Service Request

Personal Information

Last Name

First Name

Address

City

State

Zip Code

Phone Number
Day ( ) -

E-mail
Please provide driving directions so we can more easily and promptly serve you:

Type of Service:
Computer Repair
Quote/Consultation
Networking
Web Hosting
Warranty(Computer)
Warranty(Network/Internet Access)

Are you a returning customer? Yes No

If YES, please indicate customer # (located on sale invoice)

If NO, please explain how you heard of us?

Please briefly explain your computer problem or service needs:If your problem is Network/Internet Access related, please indicate the type of network (regular or wireless), operating systems of each machine
and type of machine(desktop or laptop). Skip the rest of the questions below and click SUBMIT.

Computer Brand:

Model Type:(If any...example: Vectra, Presario, Pavilion etc.)

Model Number:

Operating System:
Windows 95
Windows 98
WINNT
Windows Me
Windows 2000
Windows XP
Other

VistaTech sells and recommends:

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