Lets Fix My Jack

FixMyJack.com

FixMyJack.com "Jack's a Problem? We'll Fix It!"

Laptop Repair Form

Please carefully complete the form below.

When finished please print this page, and the press the "Continue" button to submit your Laptop Repair Request. You will be directed to a confirmation page after submitting your request, which will provide further instructions. This repair request should be printed and included with your laptop when you ship it to us for repair, or when we pickup locally. Again, Please print this page before you press the continue button.
If you have a question about laptop parts or repair prior to submitting your request, click here to use our contact form or please call us.

Repair Order

Please fill in all information in this form. By submitting this form you aree to all of our company policy posted.

Personal Information
First Name:
Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code:	(5 digits)
State:
Laptop Information
Laptop Make:
Laptop Model:
Contact Information
Daytime Phone:
Evening Phone:
Email:
Other Information
How did you hear about us?
If other please describe:
Laptop Information
I am including
Laptop works when:
I am shipping my laptop via:	(UPS, Fedex, USPS, DHL)
Laptop Serial

Specific Information
Comments:	Enter specific information on what lead up to the dc jack problem here. Please be as detailed as possible.
	I authorize FixMyJack.com to repair my laptop. I have read, and agree with their terms and conditions posted on their website. I have read this entire website before checking this box. If this box is not checked we will not process your repair request.