CheckinTest Name*FirstLast Company Name Phone* Other Number*We CANNOT begin work on your computer unless this form is filled out COMPLETELY! Address* Street Address Street Address Line 2 City State Postal / Zip Code AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongoCongo (Brazzaville)Costa RicaCote d'IvoireCroatiaCubaCuracaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor Timur)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFijiFinlandFranceGabonGambia, TheGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorth MacedoniaNorwayOmanPakistanPalauPalestinePanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint VincentSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamWalesYemenZambiaZimbabwe Country Detailed Description of the Problem Systek Computing will call for approval before repairing issues not listed above (Initial):* Other Items Left With the Computer*Power SupplyMonitorOther Choose one:Desk TopLaptopOther Multiple ChoiceDiagnosisUpgradeRepairDoes the computer require a Username or Password to access it?If we are unable to access the system due to the Password not being supplied, the password may be changed to access the system, and a $10.00 fee added to the bill in order for the technician to fulfill the work in a timely manner. User Name Password Does the computer have important data on it; i.e. accounting, word documents, family photos, etc.? YesNo Do you have a backup of your important data?YesNo Systek offers Personal Cloud Backup. Would you like to add this protection?*25gb per year $59.99200gb per year $119.99No Personal Maintenance Plans+ starting at $12.59 per month!!!$149.99 Basic or $239.99 Premium per year. * If we are reinstalling software, i.e. (Operating System, Programs) we will need all software with the required installation keys / codes. Including the Certificate of Authenticity and the Original Media. +$99.99 Setup fee applies. **Family Plans are available.** Ask your personal PC consultant for details Reinstall Software $24.99 Per ApplicationReinstallNoQuantity Software Title 1 Software Title 2 Software Title 3 Software Title 4 Software Title 5 Please read over the following: Labor rates are as follows: Total costs of services are available via the “List of Services.” If a service is not covered by the List of Services, the Systek labor rate is: $65.00 per hour billed by the ½ hour with a minimum bench fee of $65.00. We do offer OPTIONAL Expedite services:Rush Service (Available before 3:00 P.M.) $49.95 Initial-- “Rush” to the front of the queue On The Bench (Subject to technician availability) $99.95 Initial -- Placed “On The Bench” immediately PLEASE SELECT FROM THE FOLLOWING SERVICES Basic Diagnostics $39.95 • Includes a hardware scan and software scan to identify issues with your machine. Does NOT include any repair work. If you think something is wrong, this may identify the issue. PC Tune-Up $119.95 • Includes Basic Diagnostics, Basic Virus and Malware Removal (OS and Software reinstall NOT included). • Includes Installation of customer supplied Anti-Virus and Anti-Malware Software Virus Removal $129.95 • Comprehensive Virus and Malware Removal. HD Replacement $129.95 PLUS Hardware • Includes removal of the old and installation of the new Hard Drive and up to 1 terabyte of data transfer. • If Hard Drive NOT purchased from Systek a $24.99 fee may apply. Data Transfer $99.95 PLUS Hardware • Includes transfer of up to 1 terabyte of data from one working Hard Drive to another working Hard Drive. • Customer may provide a working drive or purchase one from Systek. Data Recovery $199.95 PLUS Hardware • Systek will attempt to recover data from a failed Hard Drive. SYSTEK CANNOT GUARANTEE DATA RECOVERY • Data recovered will be placed on a customer provided USB Drive. Or customer may purchase from Systek a USB Drive or other storage device. • In some cases, Systek may need to purchase hardware such as an identical hard drive in order to utilize components in the data recovery process. Customer will be asked in advance to approve such purchase and will be responsible for the cost of such hardware. Non-Touch Laptop Screen Replacement $129.95 PLUS Hardware • Includes removal and installation of a new laptop screen. • If replacement screen is not purchased through Systek, a $24.99 fee may apply. PC Rebuild $199.95 PLUS Hardware • Install/Upgrade Hardware, OS Reinstall, 2 Productivity App Reinstalls (MS Office, WordPerfect, etc.), setup of 1 email account on PC, reinstall of customer supplied AV and Anti-Malware software. • All additional Hardware and Software required must be purchased from Systek. Hardware and Software NOT purchased from Systek may be subject to a $24.99 fee for each item. Scratch Build Your New PC $99.95 PLUS Hardware • You work with Systek personnel to select just the right Hardware and Software. Systek will assemble the Hardware, Install the OS and up to two productivity applications, Anti-Virus and Anti-Malware applications, configure 1 email account and test that everything is working (burn-in). • All additional Hardware and Software required must be purchased from Systek. Hardware and Software NOT purchased from Systek may be subject to a $24.99 fee for each item. DC Jack Replacement Non-Solder $119.95 Or Solder $199.95 PLUS HardwareSystek Computing assumes no responsibility for loss of data. Systems (computers, etc.) that are left for more than 30 days after completion are considered abandoned and will be disposed of accordingly. A description of the services that we offer as well as what you should expect from the repair as well as a list of those things that Systek Computing cannot guarantee nor can it be held responsible for, can be found on our website at the following link: Repair Terms . By submitting this form I agree to these terms and agree to the labor rates as they have been stated. Sales Tax USD Total SubmitReset