Repair Request Form

Does your equipment need repair? Fill out this form.

Questions for Repair Request Form

1.

Request Date

The answer should be a date input.
2.

Name

The answer should be a text input.
3.

Phone Number

The answer should be a phone number.
4.

Email

The answer should be a email input.
5.

Address

The answer should be a text input.
6.

Street Address

The answer should be a text input.
7.

City

The answer should be a text input.
8.

State / Province

The answer should be a text input.
9.

Postal / Zip Code

The answer should be a number input.
10.

Equipment Information

The answer should be a text input.
11.

Upload photos of the equipment that needs repair

File needs to be uploaded.
12.

Was the equipment listed above been repaired for the same issue

The answer should be a single choice:
  1. Yes
  2. No
13.

Was the issue caused by accidental damage like water spill, equipment was dropped

The answer should be a single choice:
  1. Yes
  2. No
14.

Payment method

The answer should be a single choice:
  1. Cash
  2. Credit card
  3. Others
15.

Do you have any special instructions

The answer should be a text input.

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