SMCUs Online Service Request Form

Schedule SMCUs for Service

Use of this form will create a SMCUs Service Request
and a user account for future use if needed
NOTE: Please Include As Much Information As Possible To Serve You Better.

* Required fields

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Salutation *

Please Select Dr Mr Ms Mrs

First Name *

Last Name *

Company Name*

Address 1 *

Address 2

City * 

State *

ZipCode *

Email*

Phone *

(e.g. xxx-xxx-xxxx)

Ext

Mobile

How do you hear about us?

Please Select Friend Google Yahoo MSN Ask.com AOL Other Search Engine Magazine Ad Yellow Pages Directory Im A Return Customer Other

Location * 

Please Select Home Home Office Business

Detailed Description of issue : *

Number of PC's *

Please Select 1-5 6-10 11-24 25-50 51 plus

Category Of Service Request *

Please Select PC Installation PC Move or Relocation Computer Hardware Virus,Ad/Spy/Mal-ware Software LCD Installation Other Audio / Visual Printer Network DC Jack Repair Internet Web Site Creation Web Site Update/Addition Scanner Email Camera Remote Assistance Other

Operating System  *

Please Select Windows 7 Windows Vista Windows XP Pro Windows XP Windows Media Center Other What is "Window"

Does this location have high speed (broadband) internet? *

 Yes   No

Are the restore CD's for the computer available if we need them? *

 Yes   No

Scheduling

 

Requested Action

Action Dispatch a Tech Call Me Reschedule Remote Assistance

Day *

Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec   Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31   Year 2009 2010 2011

Time *

Select Time 9:00:AM 9:30:AM 10:00:AM 10:30:AM 11:00:AM 11:30:AM 12:00:PM 12:30:PM 1:00:PM 1:30:PM 2:00:PM 2:30:PM 3:00:PM 3:30:PM 4:00:PM 4:30:PM 5:00:PM After Hours

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Choice of "After Hours" schedule will be scheduled with Client pending availability.