Your name *

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Phone Number

Phone Numbers to Port

Number of Extension

Additional Features

Name*

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Email Address *

Address

Pickup Date Requested

Pickup Time Requested

Date Required Back

Service Type
Virus RemovalTune-upOS Reload (Windows or OSX)BackupHardware FailureDiagnosis

Description of Issue or Service Request

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Subject *

Issue Summary
Please fill out the following Info for us to help you smoothly. Phone Number: Operating System: (Windows, OSX, Android, iOS): Description of Issue:

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Additional Locations

Date Requested

Time Requested

Internet Provider

Number of users

Number of computers

Number of servers

Number of NAS (Network Attached Storage)

Details

Name*

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Request Type
Workstation DesktopCustom DesktopLaptopPrintersScannersToner/InkSpecial order

Budget for PC

New or Refurbished
NewRefurbished

Special Notes

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Address*

Software Interested
Microsoft OfficeMicrosoft ExchangeMicrosoft DynamicsAdobe Creative CloudDragon Naturally SpeakingOther.. {specify}

Number of computers

Notes

Name*

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Email Address *

Amount of data

Preferred Backup
ScheduledCarbonite

Notes

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Additional Locations

Date Requested

Time Requested

Internet Provider

Number of users

Number of computers

Number of servers

Number of NAS (Network Attached Storage)

Details

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Type of Hosting
PersonalBusinessEcommerce

Addons
+ Security ($20/month)ASP.NET ($5/month)Domain Name ($20/year)Additional Space ($0.75GB/month)

Domain Names

Sub Domains

Requirements / Details

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Business Name*

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Domain Desired

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Address

Notes

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Phone Number *

Address

Additional Locations

Website

Keywords

Competition Name

Notes

Name*

Business Name*

Email Address *

Phone Number *

Address

Social Media
FacebookLinkedInGoogle+TwitterInstagramPinterestOther ..Specify

Details

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Business Name *

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Your Phone # *

App Design Description

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Subject

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