Electronic Repair and Ticketing Form
1
First Name
Last Name
E-mail
Phone Number
-
Area Code
Phone Number
Device Model /IMEI #
Ticket #
Upload Image
Upload a File
Cancel
of
Describe the problem
Status:
Pending
Completed
Conclusion
Signature
Service charge paid by
Cash
Check
Debit/Credit card
Other
Submit
Should be Empty: