PC Repair Form

LC-SB27
518/442-5526/3679

Repair Request
(Note: You may type responses in this form. However, after providing the responses, the form must be printed and attached to the equipment to be serviced.)

Date: mm/dd/yyyy

Name:

Dept:

Building Room #:

Account #:

Phone #:

Manufacturer:

Model:

Serial #:

Univ. Asset #:

Purchase Date:

P.O. #:

Problem:

What has been done so far?

*** Any type of computer repair may result in the loss of data. ***
*** Backing up data is the user's responsibility. ***