Technology Repair Request

 
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 Technology Repair Request 

 
  Items denoted with a red asterisk * are required.
   
1.
*
First name / Last name
 
   
2.
*
 
   
3.
*
 
   
4.
*
 
   
5.
 
   
6.
*
Examples: Epson, Dell 1700, HP1200, Dell GX70, etc...
 
   
7.
*
Put NA if not applicable.
 
   
8.
*
Select at least 0 and no more than 0.
 
  
  
  
  
  
  
  
  
  
  
  
   
9.
*
 
   
10.
Please provide the error message seen on the screen if applicable.
 
   
 
 
 
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