Intake Form

How Did You Hear About Us?

Please select one - We like to know what we are doing right!

Customer Type

Are You A New Or Returning Customer?

New Returning

Do You Want A Copy Of This Form Emailed To You?

No Yes

Email Address You Would Like The Copy Sent To *

ex. email@outlook.com

Returning Customer Information

How Can We Locate Your Customer Account?

Name

Business Name

Cell Phone

Business Name

Name

First

Last

Cell Phone

Cell # Including Area Code ex. 555-555-5555

Can We Text You Service Updates This Time?

No Yes

We only text you regarding any current services we are providing. We will not use your phone # for marketing, sell or distribute your number for any reason to third parties.

New Customer Information

Do You Want To Be Billed Under Your Business?

No Yes

Business Name

Name *

First

Last *

Last

Email Address *

ex. email@outlook.com

Cell Phone *

Cell # Including Area Code ex. 555-555-5555

Can We Text You Service Updates?

No Yes

Secondary Phone (Optional)

Home, Office, Work # Including Area Code (Not Required)

We only text you regarding any current services we are providing. We will not use your phone # for marketing, sell or distribute your number for any reason to third parties.

Customer Address

Suite / Apartment / Unit # (Optional)

What Type Of Service Do You Need?

Service Needed (Drop Down To Select)

You can only select one primary type of service request at a time. If you have multiple issues going on at the same time, please select the most relevant service to populate the form with the fields most needed for your service type.

e.x. you want a desktop repaired but also need your wifi network checked out. You should select On-Site Repair and briefly mention the additional issues in the more information section of the form.

What Is The URL/Domain Name To Your Website?

If you don't own a domain yet, just put none.

What CMS Is Your Website Currently Built In? What CMS Is Your Website Currently Built In?

Date You Would Like To Request Service For

What Time Would You Like To Schedule?

Please keep in mind we are closed on sundays. We will also call to confirm the date and time you picked is availible within the next 24 hours.

Any Additional Information About Your Issues You Want To Provide

On Point PC Repair LLC Terms and Conditions

By having On Point PC Repair LLC provide any type of service, support, consulting, coding or designing, You (the customer) acknowledge that You have read and understand, and agree to all of the following terms and conditions:

1) On Point PC Repair LLC shall have the right to decline, deny or discontinue service at any time and for any reason and you shall still be liable for all costs associated with repairs and services rendered up to that time.

2) On Point PC Repair will make reasonable efforts to deliver repaired Electronic Devices (including but not limited to Laptops, Desktops, Work Stations, Websites, Servers, DVR's, Removable Media, Game Consoles, Cell Phones, Smart Phones, Tablets, and any cloud service) within the estimated time of delivery but does not guarantee that a repair will be completed within a specific period of time.

3) Bounced or returned checks will incur a $30 fee. If You fail to pay any invoices within 30 days of the original invoice date, interest of 1.5% per month shall be added to the balance due.  Any invoice more than 60 days overdue will result in forfeiture of Your Electronic Device(s) in our possession, which Electronic Device(s) may be retained by us or, in our sole discretion, may be discarded, sold or parted out in an effort to reclaim parts, labor and service costs we have incurred and no reimbursement of any excess recovered will be provided back to You. 

4) It is Your responsibility to maintain copies of all data on your Electronic Device(s) including but not limited to Cloud, Website, Server, Local Storage and to save such copies, aka backups, prior to authorizing On Point PC Repair to commence work on any Electronic Device(s).  On Point PC Repair shall not be held responsible and You release On Point PC Repair from all claims for any damage that occurs to the hardware, software, or data on your Electronic Device(s) or for any losses or expenses associated with any such loss.

5) When service involves transferring data or installing software, You represent that you have the legal right to copy the data and/or to use/install the software.

6) We offer no warranties or guarantees of repairs after 14 days from the date of service. Any and all damage(s), reoccurring issues, failed hardware/software, bugs, glitches, etc. that arise later than 14 days after the service date may be repaired, replaced, or refunded at our sole discretion.

7) Websites are quoted and billed by hourly rates, we always do our best to get the website built, developed and launched to your specifics within the estimated budget. However we make no promises or guarantees of the total project cost when providing an initial quote. We do bill for ideas that where developed based on clients initial design ideas or feedback and then later removed because of changes to the clients initial design concept to launch stages.

8) We will not sell your personal information you have provided on this form. However, if you have provided a valid phone number, cell number, street address or email address. We will use this information to provide you service updates primarily and may directly market to you in the future.

The foregoing terms and conditions and the Customer Intake Form constitute the entire agreement between the parties and no amendment to or modification of this agreement will be binding unless it is in writing and signed by an authorized On Point PC Repair Partner or Owner of the company.

Customers Electronic Signature

First, Middle Initial and Last Name

Today's Date

I have read and understand the above terms and agree to them.

I Agree

How Did You Hear About Us?

Customer Type

Returning Customer Information

New Customer Information

Customer Address

What Type Of Service Do You Need?

On Point PC Repair LLC Terms and Conditions

FOR STAFF USE ONLY (Customers Can Submit By Skipping This Section)