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Type of service requested Computer Install Printer Install Configure File and Printer Sharing Computer Service Computer Repair Network Service Wireless Network Troubleshooting Wireless Network Install Wireless Network Service Computer Training Audio Video Install Other

Company Name    Contact Name

 Contact Telephone Number

Address where service is needed 

City State Zip

Hardware Description:

Operating System: Windows 95/98 Windows ME Windows 2000 Professional Windows 2000 Server Windows Small Business Server Windows XP Home Windows XP Professional Windows XP Media Center Windows Server 2003 Windows Vista Linux Mac OS X Mac OS 9 or earlier Other

Do you have the Original Restore Disks for your Computer ? Yes No NA

What type of Internet Connection do you have? None Dialup DSL Cable Clearwire Satellite Cellular T1/T3

Who is your Internet  Service Provider (ISP)? None AOL MSN Qwest Cableone Cox cable Frontier cable Clear Wire Juno Mindspring Netzero

Do you have Wireless Internet Access at your location Yes No I would like to

Please describe the problem in as much detail as you can:

Is your Computer (Or Network) Down at this time? Yes No

What is the Priority of this issue No Rush Semi Important Important Business Critical

Preferred Service Date/Time

Alternate Service Date/Time

How did you hear about us? Craigslist Google MSN Search Yahoo Search Ask.com Other Search Engine BNI Newspaper Ad From a Friend From a business partner Business card from Asgard Employees Flyer/Brochure Referred by existing client

If someone referred you what is their name so we can thank them