TLCmagic Policy -- Computer Repair Ticket

This form is to smooth the receipt of computers in need of repair from customers. Revised 10/26/05.

Customer Name: ____ PC Drop-off Date & Time: ____

Address: __________ Password: ________

City, State, Zip: ____ Email: ___________

Home Phone: ______ Cell Phone: _______

Computer Symptoms:

Items dropped off with computer:

Customer Signature:______________