Geekman to the Rescue - Confidential In-Home Computer Repair






	To initiate a house call or even if you just have a question or two, please take a few moments and fill out this online service request form. Completing this online form guarantees the fastest response . . . faster than voicemail. Except those mark with an asterisk (*), not all form fields are required. Keep in mind though: the more information you can provide about your computer, the more effective and accurate the Geekman can be in assessing your needs and providing cost effective solutions.


*First Name:
Last Name:

*Email Address:
*Verify Email:

*Telephone:		Home Office Cell
(ex. 562-433-5626)		- -


Street Address:
Apt/Suite:
City:
*Zip Code:
- OR -
Indicate your neighborhood and cross streets:
*Neighborhood:
*Cross Streets:		&


Which of the following afternoons and evenings are you generally available?
Mondays:		Afternoons Evenings
Tuesdays:		Afternoons Evenings
Wednesdays:		Afternoons Evenings
Thursdays:		Afternoons Evenings
Fridays:		Afternoons Evenings
Saturdays:		Afternoons Evenings
Sundays:		Afternoons Evenings

Please indicate where you heard about
Geekman to the Rescue?

- OR -

And what is your profile/screen name?

- OR -


Please provide as much detailed information as you can about your computer system. Click the button next to each selection if you need help on where to find this information.
*Type of Computer:	Laptop/Notebook Desktop Tablet PC
*Brand Name/Manufacturer:
*Model Name/Number:	(ex. Inspiron 4600C, UNKNOWN, or CUSTOM-BUILT)
Service Tag:	(only required if you have a Dell or HP Computer)
*Operating System:
*Processor Speed:	(ex. 1.74 GHz)
*Memory/RAM:	(ex. 256 MB -or- 1.5 GB)

*Hard Drive Space:	Capacity Used Space Free Space	(ex. 18.4 GB) Capacity does not have to equal used plus free space.

*Internet Connection:	Dial-Up DSL Cable

*Automatic Updates:	Is your computer set to automatically download and install the monthy security and critical updates? Yes No I Don't Know

*Virus Scanning/Protection:	Do you have virus scanning software? Yes No I Don't Know
	Is your virus software regularly updated? Yes No I Don't Know
	How often do you scan for viruses?

*Hardware Changes:	Please indicate any internal changes you have made to your computer's hardware since you purchased it . . . check all that apply:
	I have not made any internal hardware changes
	Added or replaced an internal hard drive
	Added or replaced memory modules
	Added or replaced an internal CD or DVD drive

Please describe the problem you are experiencing with your computer. Be sure to discuss any hardware or software changes that may have occured just prior to the issues you are now having.

Be as detailed as you possibly can. You are limited to 5,000 characters in this section.

Characters remaining:

If you have an offer code, please enter it here (otherwise, ignore this section):