January 17, 2020

Customer Intake

We collect this information in order to contact you for repair updates. We do not sell your information to 3rd parties.

  • Customer Information

Customer Information

First Name

Last Name

Address

City/State/Zip Code

Phone Number

Email

Date

Device Information

Select your device type

Make

Model Number

Serial Number

Charger

Problem Description

Known Issues Description

Known or Suspected Issues

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