Service Request Form

Geek On Wheels Request for Service Form

Fill out the form completely so that someone may contact
you and discuss your needs.
Fields Marked With An Asterisk Are Required!

Enter Your Information as accurately as possible to avoid delays!
Select Location:
Full Name:	*
Email Address:	*
Company Name:
Address:	*
Address 2 (Apt. Suite #):
City, State, Zipcode:	*
Phone Number:	*
Fax Number:
Cell Phone:
How Did You Hear About Us?:
Your Operating System:	*
Services Needed:
If you dont see the service that you need listed here please add the request in the comments field and we will notify you if we provide those services and or refer you to someone who does	System Repair	Web Design
	System Upgrade	Custom Computer
	Home Network	Training / Tutoring
	Cable/DSL Install	Antivirus Protection
	Business Network	Firewall Installed
Hardware Needed:
If you need hardware repaired or upgraded what device(s) do you need or want? You may select more than one item	Motherboard	Router/Hub
	Processor	Cable/DSl Modem
	CD-ROM Drive	Memory
	CD RW-Drive	Hard Drive
	Sound Card	DVD ROM Drive
	Video Card	DVD -R/RW Drive
	Power Supply	Scanner
	Ethernet Card	Printer
Extra Notes, Comments or Requests
Enter additional comments here and describe the problem and or services needed in detail *


All Information Is Held In The STRICTEST Confidence It will never be sold or given to ANYONE outside of Geek On Wheels
Thank You!!!!

Computer Tips ~ Tech Secrets

Never open email attachments!!! unless you are expecting an attachment from a known sender attachments are the number one way people get their computers infected with viruses.

Geek On Wheels

Steve Ormand, Owner
512 N. Locust St. · · Denton · Texas · 76201
Phone: 940.382.8644 · Toll Free: 1.866.615.GEEK (4335) · Fax: 940.484.5262

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