School Name:
City:
Contact Person:
Email Address:
Telephone Number:
Fax Number:
Hardware Needing Repair:
Location of Unit: Office Classroom Computer Lab Library Modular Unit
Unit # or Identifier:
Equipment Make: Apple Epson Hewlett Packard GCC Xerox UMAX Other
Type of Equipment: Computer Printer Display Mouse Keyboard Scanner Laptop Other
Other Equipment:
Password(s):
Software Issues:
Software Title:
Version (if known):
Description of problem: Please include the number of times the problem has occured and what troubleshooting steps have been taken. Problems are more quickly resolved with detailed problem descriptions
How to contact: We would like to be added to the repair list. We would like a phone call to discuss the problem.