Project Information Form
"
*
" indicates required fields
Date
MM slash DD slash YYYY
Service ID #
*
Client PO#
*
Service Type
*
Repair
Reconnect
Please Select Service
Technician Assigned
*
First Choice
Second Choice
Third Choice
Please Assign Tech to a project
Plan Type:
*
Basic
Standard
Warranty
Billable
Client Section
Organization Name
Address
*
Street Address
Floor/Room #:
City
State / Province / Region
ZIP / Postal Code
Primary Contact:
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Prefix
First
Last
Primary Phone :
Secondary Contact:
*
Mr.
Mrs.
Miss
Ms.
Dr.
Prof.
Rev.
Prefix
First
Last
Secondary Phone :
Project Section
Unit(s) Under Repair:
Serial #
Asset Tag #
Make
Model
Add
Remove
Device Secured?
*
Yes
No
Do you need to apload extra units Details
Yes
No
Ticket Description:
File
Drop files here or
Select files
Max. file size: 1 GB.
Is Unit Damaged?
*
Yes
No
If Yes, please explain:
Diagnostics/Resolution Summary:
*
Do you need to apload extra information
Yes
No
File
Drop files here or
Select files
Max. file size: 1 GB.
Parts Details section
Part Desc. & Quantity
Part Name
Part #
*Old S/N
*New S/N
Return Tracking #
Add
Remove
Completion Section
The Status of this call is:
Date
MM slash DD slash YYYY
Start Time
Hours
:
Minutes
AM
PM
AM/PM
End Time
*
Hours
:
Minutes
AM
PM
AM/PM
PO/UD contact: Type Name:
*
Closing Section
Technician :
*
Sam Kimbing
Technician
Technician
Please Select Tech that work on the project
Technician ID #
Technician Please enter your ID for the record
Date
MM slash DD slash YYYY
Start Time
Hours
:
Minutes
AM
PM
AM/PM
End Time
*
Hours
:
Minutes
AM
PM
AM/PM
CLOSING contact: Type Name:
Please sign Document
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