Laptop Repair Order Form

* indicates required field
To request your Laptop repair, please fill out the form below. Once you have completed the repair form you will be asked for your payment details and given instructions on how to pack and ship us your laptop as well as your login information to keep track of your laptop repair.

Choose Your Order Option:

Diagnostic Only Option $49.95
Powerjack Repair Option $89.95
Keyboard Repair Option $89.95
LCD Replacement Option $299.95

Enter Your Contact Information: 

First Name:   *
Last Name:   *
Company Name:  
Email Address:   *
Home Phone #:   format: (###) ###-####
Work Phone #:   format: (###) ###-####
Mobile Phone #:   format: (###) ###-####
Preferred Contact:  

Enter Your Shipping Information: 

Shipping Address:   *
Address 2:  
Shipping City:   *
Shipping State:  
Shipping Zip:   *

  Does your billing address match your shipping address? Yes

Enter Your Laptop Information: 

Laptop Brand:   * If Other:
Laptop Model:   *
Laptop Serial #:   *

Describe Your Laptop Problem: 

  Please provide a detailed description of the problem you are having with
your laptop. If possible, please include step by step instructions to
reproduce the symptoms.
  *

Read and Accept the Terms & Conditions: 

 
  I agree to the terms and conditions above. *