Extended Warranty Service Request Form

1. Customer Details
3. I am a new customer I am an existing customer
4. First Name(required)
5. Last Name(required)
6. Company Name (if applicable)
7. Address(required)
8. Suburb(required)
9. State(required)
10. Post Code(required)
11. Fixed Line Phone No. (Please include your area code)(required)
12. Mobile Phone No.(required)
13. Email [ ? ](valid email required)
14. Referred By [ ? ]
15. Laptop Details
16. Brand
17. Toshiba HP Compaq ASUS Dell Acer SONY IBM Lenovo Other
18. Model Name [ ? ]
19. Part Number or Model Number [ ? ](required)
20. Serial Number [ ? ](required)
21. Password (If no password please enter NONE) [ ? ](required)
22. Service Request Details
23. Warranty Status
24. Toshiba Extended Warranty Claim Third Party Extended Warranty Claim
25. Claim No or SR No[ ? ](required)
26. Problem Description [ ? ](required)
27. Have you or anyone else accidentally dropped or damaged the laptop?
28. Have you or anyone else accidentally dropped or damaged the laptop?
29. Yes No
30. Have you or anyone else accidentally spilled liquid on the laptop?
31. Have you or anyone else accidentally spilled liquid on the laptop?
32. Yes No
33. Have you or anyone else attempted to repair or disassemble the laptop?
34. Have you or anyone else attempted to repair or disassemble the laptop?
35. Yes No
36. Data Instructions
37. Please provide us with instructions regarding your data (data includes programs, documents, photos and any other information stored on the computer). During the process of repair, some or all of your stored data may be lost. While we ensure that reasonable care is taken in respect of your data and/or software, we accept no liability whatsoever for loss of and/or damage to data or software applications while performing a service request. It is your responsibility to back up your data to an external device prior to obtaining our service and to retain copies of all software applications installed on your laptop. Hard disk drives that fail and need replacing will be replaced with a blank hard disk drive of equal or higher capacity with the original licensed operating system image installed; this service will result in a loss of all data and the loss of any previously installed software. Additional charges apply for software installations and/or data back- up services.
39. The data is fully backed up or is not essential, so it need not be retained
    Please make every effort to retain data but it is not crucial
    Data is essential – please contact me before proceeding if you are aware that there is a possibility that data may be lost
    Please provide me with a quote for back up or data recovery services
    
40. Additional Services (additional fees apply)
41. Do you want to book this service as a priority service? [ ? ]
43. Yes, I agree to pay the Priority Fee ($99) No thanks, Standard Level is OK
44. Do you want the latest Internet Security software loaded to your laptop? [ ? ]
46. Yes please provide me with a quote No thanks
47. Do you want to upgrade your memory for faster performance? [ ? ]
49. Yes please provide me with a quote No thanks
50. Do you want to purchase a spare battery? [ ? ]
52. Yes please provide me with a quote No thanks
53. Do you want to purchase a spare adaptor? [ ? ]
55. Yes please provide me with a quote No thanks
56. Customer Statements
57. I have read and accepted your Packing Instructions
58. I have read and agreed to your Service Terms and Conditions

 

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