Onsite Service Request
 
 
 
 


            Schedule Pickup For Shop Repair
Hourly Rate Work Order

First Name  
Last Name  
Address  
City  
State  
Zip  
Home Phone  
Work Phone  
     
Pickup Date Desired or ASAP
1 Business Day Notice Required.		  
Pickup Time Desired  
     
Billing eMail Address  
     
Repair Service Details  
Internet Troubles  
Hardware Failure  
Software Errors  
Networking Issues  
Security Problem  
Wireless  
Other    
I understand that by submitting below, a technician will be dispatched to the site address I have specified above to pickup my computer. I understand Broadlink's hourly rates and agree to pay all hourly charges upon completion of the work. I also understand there is a minimum diagnostics fee 0f $35.00.