_{Computer Repair Request Form}

Print Name:	Phone:
Address:	Email:
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Service Liability and Privacy Statement

A1 PC Repair Co-Op will use its best efforts to resolve customers technical problems in a professional, reasonable and timely manner, taking into consideration the circumstances and nature of the technical problems. Response times may be delayed due to research and inquiries, as may be necessary. A1 PC Repair Co-Op does not assure that every request for technical support will be resolved. A1 PC Repair Co-Op’s consultations constitute only advice and suggestions. Technical problems may be a result of software or hardware failure, corruption or user error and may not be correctable. A1 PC Repair Co-Op reserves the right to refrain from providing any or all services ordered and refund your payment if reasonable minus any labor, parts, or any other charges that may apply or occur, wholly or in part, if minimum system requirements are not met or if technical conditions or customer requirements are unusual, extensive, or beyond the scope of this service agreement or beyond the technicians control as reasonably determined by A1 PC Repair Co-Op. A1 PC Repair Co-Op will never share anything they may find or come across on a customer’s computer/hard drive unless illegal content or forced upon by law enforcement..

You understand and agree that prior to contacting or allowing A1 PC Repair Co-Op to perform diagnostic repair or any other services on your computer, it is your responsibility to back-up the data, software, information or other files stored on your computer disks and/or drives. You acknowledge and agree that A1 PC Repair Co-Op shall not be responsible under any circumstance for any loss or corruption of data and/or software or hardware or any other parts as well as CD's/DVD's etc… You also acknowledge if a System Reinstallation occurs, you will lose all files on your hard drive unless they have been backed up prior. You agree to pay fees in accordance with A1 PC Repair Co-Op’s rates and policies. Any computer or other computer related items, such as, software, hardware, monitors, computers, towers, laptops, not picked up or any unpaid fees that are due that go beyond 30 days, you give A1 PC Repair Co-Op the right to take ownership of any and all said items.

By signing this form, you agree to pay “A1 PC Repair Co-Op” in full for products and services rendered. Failure to pay will result in legal actions in which you agree to pay for all legal costs, including all collection fees incurred by “A1 PC Repair Co-Op” to obtain payment. Any check not honored upon presentation to a bank will incur a $20 NSF fee each time it is presented to a bank or whatever maximum is allowed by law, whichever is greater. All sales are final.

A1 PC Repair Co-Op will not be held responsible for any problems arising from third party software installed on your computer by our technicians, you, or other third party. A1 PC Repair Co-Op will not be held liable for lost data due to hardware failure, virus, spyware, corruption or any other situation. If any problems with third party software or hardware arise, it is your responsibility to obtain support from the manufacturer of the product at fault. Under no circumstances shall A1 PC Repair Co-Op be liable to you or any other person for any damages, including without limitation any indirect, incidental, special or consequential damages, expenses costs, profits, lost savings or earnings, lost or corrupted data, or other liability arising out of or related to the services provided by A1 PC Repair Co-Op or out of the installation, de-installation, use of, or inability to use your computer equipment, hardware, peripherals, or the network as a result of the services provided hereunder. A1 PC Repair Co-Op shall not be liable for any failure or delay in performance due to any cause. If A1 PC Repair Co-Op’s ability to render services is impaired by your failure to cooperate or circumstances beyond the control of A1 PC Repair Co-Op, A1 PC Repair Co-Op may choose not to provide services.

By signing this form, you will agree to release and hold harmless A1 PC Repair Co-Op from and against any loss, liability, or damage, including without limitation, any indirect, incidental, special or consequential damages, expense, costs, profits, lost savings or earnings or liability that you, the owner, or lessee may suffer arising out of, or related to, the services provided by A1 PC Repair Co-Op and all of their employees. This includes but is not limited to data loss or lack of function in any component or element of your computer system and/or peripherals as a result of A1 PC Repair Co-Op’s actions or the actions of its agents, partners, and/or third-party service providers. You agree that A1 PC Repair Co-Op’s total liability for damages related to its provision of services is limited to the total amount you pay for such services, and you release A1 PC Repair Co-Op from liability for any indirect, incidental, special, or consequential damages.

By signing this form, you are claiming the computer is yours or you have permission to allow A1 PC Repair Co-Op to perform work and claim the computer or any other items are not stolen or have contents/files of other unlawful acts.

Signature:

Date:

Make/Model:	Computer Issues
Serial Number:	□ Viruses □ Needs Antivirus □ Slow □ Pop-Ups
Product Number:	□ Crashes/Reboots □ Freezes □ Needs Cleaned
Service Tag:	□ No Video □ No Internet □ No Power
Operation System:	□ Needs hardware:
□ Tower □ Laptop □ Custom	□ Error Message

_{Items Checked In}

□ Keyboard □ Mouse	□ Power Cord □ AC Adapter	Other:
□ Monitor □ Case/Bag	□ Software

_{Summary of Repairs (Office Use Only)}

□ Reloaded OS	□ AC Adapter □ Cable	□ Keyboard □ Mouse
□ Virus/Spyware Removal	□ System Board	□ Video Card
□ Antivirus Install/Configuration	□ CPU □ Heat sink □ Fan	□ LCD Replacement
□ Windows/Drivers Updates	□ Hard Drive □ Optical drive	□ Clean/Dust Removal
□ Installed RAM	□ Power Supply	□ Other

Technician Notes:

Parts Ordered: