Personal RepairPlease enable JavaScript in your browser to complete this form.Name *FirstLastDateEmail *Phone *Address *Address Line 1Address Line 2City--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeDescription of work/issue *Repair Department/BreakFix *Diagnostic/Minimum Service.(Goes to repair cost)Computer reload (Data transfer) Two hoursComputer reload (without data) Hour and halfComputer Virus/General Cleanup. Hour and halfData Transfer/Migration/Hardware installationPersonal Repair (ONSITE) Per hour, 1 hour Min. + TravelTotal Amount$0.00Terms:I (the customer) hereby state that the work (the service) stated above will be performed to my satisfaction. I also recognize that it is my responsibility to inform Mountaineer IT of any other faults or defects within the warranty period of the work. I will pick up all items left by me (the customer) at Mountaineer IT, any items not picked up I authorize Mountaineer IT to recycle. Claims of damage done by the work (dents, scratches, etc...) must be made at the pickup time and not after. Claims made after are null and void.. Mountaineer IT guarantees the labour of the work for a period of 30 Days. I recagnize that if item’s left over 90 days of signed date, are subjet to recycling. Mountaineer IT will try to contact you over phone and email three times before recycling abandoned equipment. I (the customer) allow Mountaineer IT to back up my personal data off my computer or mobile device during events such as a failing hard drive, system reload, data recovery. Data will be stored on a secure Mountaineer IT owned media. Customers must provide and is soley responsible for all software licenses installed or wanting to be installed on his or her computer. Mountaineer IT strives to recover licences on failed computers but cannot always retrieve software licenses due to software security and license agreements.Signature______________________________________________________DATE_______________________________Submit