Customer
Work Order Agreement
Please
fill out all requested information: (print legibly)
Name:
__________________________________________________________
Street
Address: ___________________________________________________
Mailing
Address: _______________________________________zip: _______
Home
Phone: ______________________Fax #: _________________________
Alternate
Phone: __________________________________________________
E-mail
address: ___________________________________________________
List
all hardware and software items being submitted for this work
order (be as specific as possible):
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Is there any valid warranty on the equipment? Circle one: YES
NO
If
YES, who is the warranty from? _____________________________________
Describe
the specific problem on this work order:
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
Describe
any incidents that may have occurred prior to the problem(s) you
are
experiencing:
(ex: software was installed, power went out, hardware was installed)
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
What
is the monetary limit (if any) you want to set on the work to
be done: _____
(there
is a minimum of one hour labor charge for all work performed)
CUSTOMER CONSENT AGREEMENT:
I
hereby authorize Both Brain Hemispheres to perform all work necessary
to resolve the problem(s) as listed above. My signature below
verifies that I either have a current back-up of all of my data
or that I have no data that must be preserved on the equipment
being submitted for work. I understand that Both Brain Hemispheres
is in no way responsible for any data that is on any of the equipment
being submitted for this work order. I understand that any equipment
not picked up within 10 days of the completion of the work order
will be considered abandoned and may be disposed of or donated.
Authorized
signature: _______________________________ Date: _____________
