Laptop Repair Request

Please carefully complete the form below. Before you press the Submit Button please print this page twice. Keep one printed copy for your records and mail the second printed copy with your laptop when you ship it to us for repair.

PLEASE READ

Please use this laptop repair request form only if you are mailing your laptop to us for repair. If you have a question about laptop parts or repair prior to submitting your request, please call us at 734.981.6600.

NOTE: If you have an International unit, please inform us. Parts availability is limited for International units and therefore may not be repairable.

CONTACT INFORMATION	* denotes required field
Canton Computers currently ships to U.S. destinations only.
Company:
Name *:
Street Address*:

City, State, Zip Code *:
Day time phone number *:

Your e-mail address will be used for repair status correspondence.
Email Address *:
Retype Email Address *:

LAPTOP INFORMATION
Laptop Brand *:	Other *:
Laptop Model *:
Laptop Serial Number:
Is your laptop an international (non-US) model?

Please provide any System or Windows login/password information required to access your laptop operating system.

PROBLEM DESCRIPTION *

Please provide a detailed problem description. Error numbers and Error descriptions are extremely helpful in determining the problem. If possible, please include detailed step by step instructions to replicate the problem.

LAPTOP WARRANTY STATUS
Please indicate if the laptop is in-warranty or out-of-warranty with the manufacturer. *.
	In Warranty	Out of Warranty

Date Laptop Purchased:

ADDITIONAL UPGRADES
In addition to your primary repair service, if you would like a quote on additional upgrades to your laptop, please select from the list below.
	CDRW Drive	DVD Drive
	DVD CDRW Combo Drive	Hard Drive Upgrade
	Memory Upgrade	Keyboard Replacement
	Operating System Upgrade

ADDITIONAL ITEMS SHIPPED WITH YOUR LAPTOP
Please include your AC Adapter and Power Cord with your laptop to avoid possible delays in your repair. It is also helpful to include an additional battery if you have one. Please select any other items being shipped with your laptop.
	AC Adapter and Power Cord	Battery
	External Floppy Drive	External CD-ROM / DVD Drive
	External Hard Drive	Carrying Case
	Software/Restore CD (required if you want us to restore your OS or other software)
Additional Items not listed above

WARRANTY AND LIABILITY STATEMENTS
Please check each statement below confirming that you agree to the terms and conditions set forth for any repairs performed by Canton Computers *.
	I understand Canton Computers is not responsible for any software or data lost on my hard drive. I am responsible for backing up the data on the hard drive prior to shipping the unit to Canton Computers for repair.
	I understand that Canton Computers is not responsible for keeping or returning defective parts that are replaced as part of the repair unless specifically requested by the customer prior to acceptance of our repair estimate.
	I understand Canton Computers is not responsible for any damage caused to my laptop during shipping to AND from our location. I understand that Canton Computers will insure my laptop for $999.00 during return shipment and if additional insurance is desired, I am responsible for notifying Canton Computers and covering the additional insurance expense.

STOP and READ

Before you press the Submit Button please print this page twice. Keep one printed copy for your records and mail the second printed copy with your laptop when you ship it to us for repair.

Ship laptop to:

Canton Computers

1765 Canton Center Road

Canton, Michigan 48187

734-981-6600 - Fax 734-981-5131