Service Request Form
Please fill form out completely as possible
(* required)
Contact Name:
*
Date:
Phone Number:
*
Fax Number:
E-Mail:
Customer Refrence:
Customer Name:
Customer No.:
Your Ship To:
Address:
*
City:
*
State:
*
Zip:
*
Select One
On-Site
Depot (In-Shop)
1
Requires proof of purchase to be
forwarded to Data-Star Computers.
Select One
Warranty
1
Non-Warranty
Select Type:
Parts & Labor
Contract Maintenance
Make
Model
Serial #
Description of Service Request
