Repair Form - NexGen Tech Repair & IT Solutions

First and Name

Enter Company Name (optional)

Enter Home OR Work Address

Enter City

Enter State

Enter Zip code

Phone Number

2nd Phone Number (optional)

Device Information:

Device Brand

Serial Number

User Name

Password

If a pattern, please draw it here by checking the boxes:

Draw password

1 2 3

pw-line2

4 5 6

pw-line3

7 8 9

Please confirm by entering the number sequence of the drawn pattern:

PW draw confirm

Check-in Condition:

Check-in Condition:

New Slightly Used Used Smashed OR Broken

When was the data last backed up?

Not sure? Days? Weeks? Year or more?

Do you have photos of the damage to the device?
If so, you can upload them here (up to 4 images in Jpg or gif format):

file upload

When was the data last backed up?

Data Services Most people have irreplaceable pictures, documents, movies & music on their computers. As such we recommend everyone preform regular data back‐up. We can back up your data at extremely competitive rates.

Do you Require Backup Services?:

No, I do NOT need backup services YES, I DO need backup services

Acknowledgment of Terms and conditions Policy on Data loss

Requested repair and/or installation service may cause partial or complete data loss from your equipment. You must maintain backups and assume all responsibility for restoring any loss of data or software. RCR Repair offers a data backup service to assist In this process. Responsibility for Charges All charges are due and payable before any equipment will be release. A valid proof of purchase must be provided before any warranty work will be performed. Operating system corruption, software configurations, virus and malware detection\removal and “No problem Found” are not covered by the manufacture’s warranties and normal non‐warranty diagnostic and repair rates will apply.

Acceptance

(*Required)
I have read and AGREE with the Acknowledgment of Terms and conditions Policy on Data loss