Computer Service Request
*Items marked with an astrick are required*
What is your name? *
Are you an existing customer of On-Site Computers, Inc. *
YES
NO
Answer Required
Business Name (If applicable) *
Address *
City, State, ZIP *
Email Address
Business / Home Phone *
Cell Phone
How do you like to be contacted? *
Phone
Email
Fax
Mail
How did you hear about On-Site Computers?
Ad
Yellow Pages
Referral
Web
Other
What type of system is it? *
Desktop
Laptop
Who is the manufacturer? *
On-Site Computers
Dell
Gateway
HP
Compaq
Sony
Other
What is the serial # or Service Tag? *
What type of problems are you experiencing?
*Pick as many as
you need*
Will not turn on
Running slow
Internet pop-ups
Noise coming from system
Internet/email does not work
Lost data files
Error msgs pop-up
Install Software / Device
Other
Additional Information
Do you have a current Backup? *
Yes
No
Do you need On-Site to do a backup? *
Yes
No
Will you be taking the
computer to one of
our stores or
requesting a
technician to come to
your site?
Onsite Service Call
Grand Meadow
Kasson
Preston
* = Input is required