Client Contact Card

First name*

Last name

Email*

Phone*

Preferred Method of Contact*

Phone

Email

Text

Brief Scope of Work Desired*

Type of Service Visit Desired*

Home Visit

Work Visit

Public Service Location

N/A

Are You Ready To Schedule IT or Computer Repair Services?*

Yes

No

If yes, please provide service address*

Request Priority Level*

Low

Medium

High

Critical

I understand CRC Tech Solutions provides mobile computer repair. A private or public service address will be required to receive services.

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