Personal Details

*First Name:

*Last Name:

*Email Address:

*Confirm Email:

*Phone Number:

     Preferred Contact Method:
     Phone     Email

*Home or Business:
 Please Select ! Home User Home Business Small Business Medium Sized Business

Business Name:

*Do you require Onsite Service?   
Please Select ! Yes, please visit me onsite at my home or business           No, I will drop off to Latham No, but please arrange pickup and delivery Not Applicable

Address:

Suburb:

City:

State:

Country:

Postcode:

Best time and day for your Service

Day of Week:
 Please Select !         Any Day ASAP! Monday Tuesday Wednesday Thursday Friday Saturday Sunday Other

Other:

Time of Day:
 Please Select !         Any Time ASAP! Morning Afternoon Evening Other

Other:

*Enter service details:
Please describe the computer service you require. If you have a PC problem, please give details of any error messages, as well as anything you've tried to fix the problem already. Try and quote exact wording of any errors, as this can make your service quicker and also cost you less! (Please delete this text!)

*How did you hear about us?

 Please Select !         Previous Client Friend Work Collegue Other Referral Google Search Nine/MSN/Live Search Yahoo Search Other Web Search Other

Search or Referral details (from above):

(Optional) Computer Details

Please complete any relevant details to help service you better.
...if you don't know any details just leave them blank!

Computer Type:
 Please Select !         Desktop Laptop Server Other Not Applicable

Model/Brand, if any

Year of Purchase:

Windows Version:
 Please Select !         Windows Server Windows Vista Windows XP Windows 2000 Windows ME Windows 98 Other Not Applicable

Office Version:
 Please Select !         Office 2007 Office 2003 Office 2002/XP Office 2000 Office 97 Other Not Applicable

Other:

Antivirus:

Antispyware:

Firewall:

Processor (CPU)::

Memory (RAM):

Any Other Details:

Internet Type:
 Please Select !         ADSL TransACT Broadband Dial-Up Other Not Sure

Internet Service
Provider (ISP):

Do you have a Backup?  Please Select !         Yes No Not Sure

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