This document contains a check-in form for customer equipment being serviced. It requests customer contact information such as name, address, phone and email. It documents the equipment brand, model and any issues. It also contains policies on data loss and liability, diagnostics fees and refund, and charges and equipment pickup. The customer must sign acknowledging they understand these policies.

1. Customer Contact Information
Company Name:
E-mail:
Condition of Equipment
Tablet
LaptopDesktop
Service Repair
Check-in Form
Bench #:
Date:_____________
Time: ____________
User Name: Password:
Street Address:
Last Name: First Name:
Zip:
Phone 2:Phone 1:
City, State:
Equipment Information
Key: Yes / NoOS:
Brand/Model:
Other:
Tech willl note condition of customer system:
Power Adapter: Yes / No
System Booting: Yes / No _______
Policy on Data Loss/Waiver of Liability - Services may cause data loss. You the customer assume all responsibility for restoring lost
data/software. Texas PC Geeks assumes no responsibility for any software/data loss or restoration. In no event shall Texas PC Geeks be held
liable for any consequential or incidental damages due to lost data, lost programs, or defects in parts or lost productivity. The total liability of
Texas PC Geeks shall in no event exceed the total sum paid to Texas PC Geeks for data/backup service. The customer acknowledges this
limitation of liability and risk ____________ . Backup Declined ____________ .
Diagnostics - Diagnostics/estimates are free except when the repair is declined. A 25.00 fee would be assessed in such
situations. ____________ .
Refunds: Refunds for parts will be refunded with 30 days of request of refund if approved by Texas PC Geeks ____________.
Responsibility For Charges - I acknowledge responsibility of charges. Texas PC Geeks will not be responsible for equipment left after 30 days.
Unclaimed equipment held after 30 days will be sold to cover repair costs ____________ .
Angies List
Referred by:
Ask
Yahoo
Bing
Estimated Cost of Goods / Services excluding tax: $
All Quotes and Estimates are Subject to Service Manager Approval
I authorized repairs listed above not to exceed quoted amount:
x
Estimated Date of Completion on or before:
Date: Time:
Tech Notes:
Tech: Mgr:
List services requested and / or the symptoms affecting your computer in your (customer’s) words
Service not requested in writing will not be performed: _______
There is no need to call for status, our technicians will call if questions arise or if your system is finished
before the completion date. Thank you for choosing Texas PC Geeks for your PC repair! -
How did you
hear about us??
Google