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EQUIPMENT TYPE Equipment Type Projector Monitor Laptop MAKE MODEL SERIAL NUMBER UNDER WARRANTY? Yes No PLEASE DESCRIBE THE PROBLEM IN DETAILS. IF YOUR COMPUTER IS PASSWORD PROTECTED PLEASE PROVIDE PASSWORD ARRANGING Select Arrange Pickup -Local Arrange pickup by UPS I will bring it in myself I will ship it myself CONTACT / PICKUP TIME 10-11am 11-12noon 12-1pm 1-2pm 2-3pm 4-5p APPOINTMENT FOR Select Monday Tuesday Wednesday Thursday Friday YOUR NAME COMPANY OR DEPARTMENT PHONE OFFICE PHOME HOME CELL EMAIL ADDRESS ADDRESS SUITE / APT CITY STATE Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Dist. of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Mariana Islands Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming ZIP ADDITIONAL REMARKS HOW DID YOU FIND US Select On the Internet Yellow Pages Refferl Fields Required Limitation of Liability: In no event AvalonTC be liable for any loss of user data, use, revenue or anticipatory profits, or for any direct or consequential damages arising out of or connected with service, sales or operation. By submitting this work order you agree to pay any diagnosis charges associated with this work order.