Please describe the problem(s) you are having with your PC

What type of computer do you have?

 	  			
             Please select:
   				   PC
				      Laptop/Notebook
   			
	
         

Which version of Windows do you run?

 	  			
Select an Operating System:
   				   XP
   				   Vista
				      Other
   			   
	
             Which Version:
         

Do you have your Original Operating System Disks and their Licence Key?

 	  			
             Please select:
   				   Yes
				      No
   			
	
         

How old is the PC?

 	
      Is it under warranty?
				     No
   				   Yes
   			
	
         

Who is your Internet Service provider?

Type of Internet access?

 	  			
                Select one:
   				   ADSL
   				   Dial Up
				      Wireless
   			
	
         

What AntiVirus and/or AntiSpyware Protection do you have

            Please List:
                      
         

How many User Accounts are on the PC?

Can you provide their passwords. Yes No

is this PC used for business? Yes No

              Given Name:*
                 Surname:*
Company or Business Name:
  
        Street Address 1:*
        Street Address 2:
                  Suburb:*
                   State:*
                Postcode:*

 Postal Street Address 1:
 Postal Street Address 2:
           Postal Suburb:
            Postal State:
         Postal Postcode:
 
                   Email:*
                     Tel:*
                     Fax:
                  Mobile: