CLNW Intake Form

Completion of this form is required for service

Contact Name
Phone Phone - ### - ### ####
Email
Address Address
Street Address City State / Province / Region Postal / Zip Code
REQUIRED ITEMS

Please bring the required items listed below:
Power Supply, installation disks, software licenses, peripherals involved in experience problem.
Type of Equipment:

Type of Equipment: Desktop Computer Laptop Computer Monitor Printer Other Other
Equipment/software checked in:
Equipment Make/Model Number:
Serial Number/ID Number:
Login Password

Please provide the PIN or password for the default user on this device when starting
Issue Summary

This will be the ticket title.
Description of problem/work to be done:
If necessary, may we delete all files (data and software programs) in order to re-install the operating system and make the computer functional again?

If necessary, may we delete all files (data and software programs) in order to re-install the operating system and make the computer functional again? Yes No - customer will be contacted if data loss is required.
Disclaimers

Disclaimers Customers are responsible for their own data We take no responsibility for data loss. Please perform a data backup prior to work. ($24.95 labor fee) Software restoration can only be done for licensed software with customer provided software Any items left over 45 days from date of repair will be considered abandoned and sold to recover the cost of expenses accrued by Computer Link Northwest, LLC. Labor rate for work not included in initial service quote will be billed at $95/hr.
Technical Notes Below

Add relevant technical notes below:
Microsoft Login
Microsoft Password
Google Login
Google Password
Google 2FA
Other Passwords/Issues/Details for tech:
Services to be performed (Estimated Cost)

Services to be performed (Estimated Cost) Basic Diagnosis ($79) System Tuneup ($79 - $129) Hardware Repair ($129 - ???) Software Installation ($49 per application) Operating System Installation ($129) Windows Update Install ($79) Malwarebytes ($49) Avast Antivirus ($29) Data Transfer ($79 - $129)

Prices listed are an estimates only. Depends on the amount of data, hardware costs, and time involved in the actual work.

CLNW Intake Form

CLNW Intake Form

REQUIRED ITEMS

Technical Notes Below