HD Imaging, Inc./GLA Sat System, Corp

SERVICE INFORMATION                                            Warranty:  YES       NO

 

NAME:                                                                    DATE:                                                    

 

COMPANY:____________________________________

 

ADDRESS:                                                                                  

 

CITY, STATE, ZIPCODE:                                                         

 

PHONE #:                                                              CELL PHONE #:                                  

 

EMAIL ADDRESS:                                                                     

 

IS THIS AN EMERGENCY:       YES           NO          NEED BY DATE:                        

 

MODEL:                                                                 SERIAL #:                                             

 

ACCESSORIES:       YES           NO             TYPE:                                                          

 

PROBLEM:                                                                                                                         

 

                                                                                                                                             

 

                                                                                                                                             

 

                                                                                                                                             

 

***IF POSSIBLE PLEASE PROVIDE THE TAPE***

 

 

OFFICE USE ONLY:

 

DIAGNOSIS:                                                                                                                      

 

SERVICE PERFORMED:                                                                                                

 

                                                                                                                                             

 

                                                                                                                                             

 

 

RECOMMENDATIONS:                                                                                                   

 

                                                                                                                                             

 

INVOICE #:                                                   

 

DATE COMPLETED:                                     CUSTOMER PICKED UP: