EIT Service Request Form

Online Service Request Form

Complete form below.
Read disclaimer info.
Click the "Submit Form" button.

Customer Information

Name:

Purchase Order#:		Company:		Address:

City:		State:		Zip Code:

Contact:		Telephone:		Email Address:

Warranty:	Warranty Non-Warranty

Description of Problem/Equipment Details

Description of Problem:		System Down:	Yes No	Equipment Type:

Make:		Model:		Serial Number:

Comments:

Customer Billing Information

Billing Info Work Ph#:		Billing Info Name:		Designation

Billing Info Phone/Fax:		Billing Address if different from above:

Disclaimer
* Customer will be charged a minimum $45 diagnostic fee (inshop) for all non-warranty repairs which may be applied to the repair. Onsite visits are at standard hourly rate. Disclaimer: Customer is responsible for all data on their hard drive being backed up prior to repair. EmbarkIT is not responsible for backing up customer data prior to a service repair. * Disclaimer: If a Warranty Repair issue is determined to be a software issue, rather than a hardware issue, customer is responsible for Payment of the technician's time involved as software is not covered under any manufacturer's warranty.

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EmbarkIT, Inc.
1303 50th Street, Suite 100 West Des Moines, IA 50266
Phone: 515-440-1451 / Toll Free: 866-440-1451 / Fax: 515-440-1455