Fill out and "SUBMIT" this form to request on-site service from a MicroAge Technician. Upon submission, your information will be immediately forwarded to the Service Manager, and you will be contacted for final verification. 

Please supply as much information as possible to expedite this request .

CONTACT INFORMATION: *Name  Company  *Home Phone  *Work Phone  E-mail  Address  What is the best way to contact you?     SYSTEM INFORMATION: Operating System: --Select One-- Windows 95 Windows 98 Windows 2000 Windows ME Windows XP Windows NT Other  *Is this a MicroAge Custom-Built System? Yes    No If Yes : Serial#    (How to find your serial number.) If No : Make/Model: Serial# In order to help us better understand the problem and recommend the appropriate course of action, please be very specific with the problem description.  Include any Error Messages exactly as they appear on your screen, and describe what you were doing when the problem occurred. *PROBLEM DESCRIPTION (Symptoms):