Personal Info

Nearest Metropolitan City *

Full Name *

Company Name

Cell Phone Number * Cell Phone Provider* ALLTEL AT&T Boost Mobile Cingular Cricket Metrocall MetroPCS Nextel Sprint T-Mobile Verizon

Additional Number

Email Address *

Street Address *

City * State * AL AK AS AZ AR CA CO CT DE DC FM FL GA GU HI ID IL IN IA KS KY LA ME MH MD MA MI MN MS MO MT NE NV NH NJ NM NY NC ND MP OH OK OR PW PA PR RI SC SD TN TX UT VT VI VA WA WV WI WY Zip *

Years In Field * Number of Service Calls Completed *

Please describe your
on-site IT experience *

What is your availability?

Check all that apply: * Weekdays Weeknights Weekends & Holidays

What jobs you are qualified to perform?

Check all that apply:*

General Windows / Virus Removal / Desktop Hardware Replacement / Wireless Home Networking
Printer Diagnostic and Repair of specific printer part failures - paper jams, error codes
General Mac Problems, slowness, application problems, peripheral upgrades
Server Support, Active Directory, MS Exchange Issues, RAID troubleshooting
Inside Wiring and Phone Jack Installation

Agreement

By checking this box I certify that I have read and agree to the contractors agreement.
You must agree to our policy to submit!

Reset Submit * If the form does not submit, please ensure you have filled out ALL of the required fields correctly.