Personalized Solution Request Form
Please fill out all required fields below. We will generally contact you within 1 business hour.

Questions? Call 1-800-245-3002 for immediate assistance. We also offer 24/7 Emergency Service.


   CONTACT INFORMATION:
First Name: *Required
Last Name: *Required
Company:
Address:
City:
State:
Zip Code:
Phone Number: *Required
Alternative Phone:
Fax:
E-Mail: *Required
   COMPUTER SPECIFIC INFORMATION:
Manufacturer:
Model:
Operating System:
   NETWORK SPECIFIC INFORMATION:
Router Manufacturer:
Model:
Internet Service Provider:
Connection Speed:
Number of Servers:
Number of Workstations:
Number of Personal Computers:
   PROBLEMATIC DEVICE SPECIFIC INFORMATION:
Manufacturer:
Model:
   SYMTOMS:
Device Has Stopped Working:
Device Has Error Lights Showing:
Computer performance has slowed:
Computer Locks-up, or freezes:
Computer Blue Screens:
The computer spontaneously reboots or turn itself off:
Strange noises and vibrations:
Your home page, default search engine, or web browser has changed itself:
No Longer Connects to Internet:
Pop-ups and Error Messages:
   PLEASE PROVIDE ADDITIONAL INFORMATION REGARDING YOUR CASE:
   Circumstances of Problem or Inquiry:
   What solution attempts have been made:
   Please list what is most important to you for customizing your solution: (i.e. Time, Cost, Best    Solution, Preventing Reoccurrence, etc.)
Request Type:
Is This an Emergency?
We will contact you immediately. 		     






24/7 Support


For the LA & OC Area
Call Us: (800) 245-3002

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NAME
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PHONE
ADDRESS
CITY
STATE
ZIP CODE
FAX
# of PCs