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Electronics ER
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Intake form
Help us serve you better
Name
*
Email address
*
Phone number
Preferred contact method
Select
Phone
Email
Type of device
Please select at least one option.
Smartphone
Tablet
Laptop
Desktop
Game Console
Brand of device
Please select at least one option.
Apple
Samsung
Google
Microsoft
Dell
HP
Lenovo
Issue description
Preferred appointment date and time
How did you hear about us?
Select
Social Media
Search Engine
Friend/Family
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Which service or services are you interested in?
Please select at least one option.
Smartphone repair
Tablet repair
Laptop repair
Additional questions or comments
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