Cracked Device Repair Form

Cracked mobile screen

Please fill out the information below to receive a quote to fix your device.  You will be sent an estimate.  Once you agree to the repairs, we will send out instructions on shipping or setting up an appointment to meet for repairs.


 

 

 

Customer Information

Your First & Last Name (required):

Address (required):

Your Email (required):

Your Phone (required):

Perferred method of contact:
EmailPhoneEither


Device Information

Make (required):

Other Device not listed above:

Model Number (engraved on back of product) (required):

Model Number not listed above:

Device Color (required):

Check to have tempered glass added for more protection (extra $10):
Yes, Add Tempered Glass

Additional Comments or Information:

Promotion Code:

Initial Shipment (what are your plans for initial shipment?):

Return Shipment Request (required):

Is this a corrected repair form to update one recently sent:
YesNo

Submitting this form doesn't obligate you in any way to use our services. You do agree to receive messages about our services, though, which you can opt-out of anytime. We don't like spam, either, and never share your information.

Yes, I Agree to These Terms

By checking this box I hereby understand and agree to the details of this order and the Terms and Conditions of My Computer Solutionz. You may cancel this order at anytime prior to making your payment.

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