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Quantum Repair Service Request
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Name
First Name
Last Name
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2
E-mail
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3
Phone Number
Area Code
Phone Number
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4
What is Your Operating System?
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5
Computer Make and Model
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6
Describe the Problem
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7
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8
By checking the box below you agree that Quantum Repair has received your computer and they are not responsible for any data loss during their repairs.
I Agree
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9
Signature
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