SteelCity Computer Repair Request Form:

*First Name:

*Last Name:

*Street Address:

Address  Line 2:

*City:

*State:

*Zip Code:

*Phone Number USA only:

Email Address:

Services

*What version of Windows are you running?

 Windows Vista

 Windows XP

 Windows 2000

 Windows 98

*Computer Services:

 $50 for the first fix, $.95 cents a minute thereafter

Flat rate - General tune up - $75

 Flat rate - Full PC clean up - $125

*Are you over the age of 18?

Yes

No

*Do you live in the USA?

Yes

No

* Indicates Response Required