REPAIR ORDER

Personal Details * Contact Name Company Name Address * Phone Number Mobile Number * Email  System Information * Operating System: ---------Please Select---------- Windows 2008 - Server Windows 2003 - Server Windows 7 - Ultimate Windows 7 - Professional Windows 7 - Home Premium Windows Vista - Ultimate Windows Vista - Business Windows Vista - Home Premium Windows Vista - Home Basic Windows XP - Home Windows XP - Pro Windows 2000 Windows 9x Other / Not Sure If Other - Please Specify Computer System Brand: ---------Please Select---------- Acer ASUS Compaq Dell Fugitsu Gateway HP IBM Jungle LG Spartan Toshiba Other / Not Sure Is Computer in Warranty? ---------Please Select---------- Yes No Not Sure If Other - Please Specify   * Data Backup:   I have backed up my data.   I have not backed up my data and do not want it backed up.   I would like my data backed up. Jungle Computer is not responsible for any damaged or lost data. If we are not able to back-up or recover your data, we will notify you with available options. Brief Hardware Description: Please Enter a Brief Description of your Hardware, which can help us identify the cause of the problem. Networked Computers: ---------Please Select---------- 2 Computers 2 - 5 Computers 5 - 10 Computers 10 + Computers None * Internet Access: ---------Please Select---------- T1 Cable DSL Wireless Dialup None Brief Problem Description: Please Enter a Brief Description (including error message) of your Problem, which can help us identify it's cause. * I authorize the Jungle Computer Repair Technicians to perform the above work on my computer. I understand and agree that my submission on this form is required for all repairs. I also understand and agree that I will be responsible for payment for all services rendered per our price quote and that I must pay for the repairs prior to or at the time I pick up my equipment. * Enter Below Code Precisely As Shown:  Reload Image

Before submitting please make sure of the following;

   * All necessary information has been filled out.
   * All information is correct and error-free.

We have:

   * 38.107.191.84 recorded as your IP Address.
   * recorded the time of your submission.