Net Tech Shop

Customer Information Sheet/Work Order

Date and Time: _______________________

Work Order Number: _____________________

Name: _____________________________

Contact Number: _________________________

Address: _____________________________________ City, State, Zip: _____________________

Is the problem hardware or software related or both?

Hardware > Software >

Both >

Brief description of problem:

Is there any data that CAN NOT BE LOST ON THE COMPUTER? YES >
NO >
If yes what is the location of the data? (Please understand that if the disk drive is damaged data recovery may not be possible)

Estimated time to repair:

Will any hardware have to be purchased?

YES >

NO >

MAYBE >

Customers Please Read and Sign

PC maintenance is very risky in terms of data integrity. You are responsible for backing-up your data before bringing your computer
for repair or upgrade. If you cannot back up your data before we attempt to repair, we will attempt to back up the data for you if
possible. The Virginia College Tech Shop and its employees are not liable for lost data or any damages resulting from lost data; nor
are we responsible for additional problems or damage that may occur while we are in possession of your equipment. Our technicians
use the latest technology and the greatest care to insure your equipment is serviced swiftly and effectively.
Thank you so much for your business!

If you agree to the above information, please sign your name below:
Signature: ______________________________

Date: ______________________________