Dell Personal Computer M5010 Repair Form

User Manual: Dell Personal Computer M5010

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Computer Repair Request Form
pc mania

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Computer Repair Services
41 Walnut Ave.
Norwood, MA 02062
(781) 688-0288
Customer Information
Name

Phone Number

Address

email
State

City

Zip Code

Ebay User ID

Please don't send your charger and battery. We are not responsible for any charger and battery losses
Information About Your PC

Insurance

What's Included In Your Package

Hard Drive

Brand Name

Check If you bought Insurance

Memory / Ram

Model Number

Note:
If you didn't purchase Return
shipping insurance separately,
your package will be only insured
for $100

How Did You Pay ?

Serial Number

Paypal

Motherboard Only

Credit Card

where did you purchase the service

To Purchase Return Insurance
Please Visit
www.mypcmania.com/insurance.html

Money Order

Ebay

Personal Check

WebSite

Not Yet Paid

Tell us, whats wrong?
What is wrong with the PC? Be as detailed as possible.

For Office Use Only

Signed By
Date
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