The PcComputerGuy

Customer Request Form

On-Site Service Request (Indianapols & Sorrounding Area)

Need On-Site Help? You've come to the right place!
Please Complete the following form as much as possible and I will contact you promptly to confirm our appointment!

Residential Rate:

$50/Hour New Customer Special (For new residential customers, on the first visit.)
$60/Hour Regular Rate

Business Rate:

$60/Hour New Business Special (For new business customers, on the first visit.)
$90/Hour Regular Rate

Contact Information:

First Name:
Last Name:
Phone (Include Area Code):
Address:
(apt/unit/space):
City:
State:
Zip:
E-Mail:

Computer Information/Issue:

Operating System
Computer Make/Model :	(Ex. Dell Opi260)
Describe Issue/Trouble

Please make appointment at least 24 hours in the future. If you require more immedeate service, please give me a call!

Requested Appointment Time: (10 A.M - 7 P.M)

Date Requested:	(Ex. 09/25/2006)
Time Requested:	(Ex. 10:30AM)

The PcComputerGuy will call and confirm the information and appointment time/date. Appointments are not "set" until they are confirmed.