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Please enter your contact information so we can contact you in regards to providing you Computing / IT Services.
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Company (if applicable)
Primary Contact Information
Mr.
Ms.
Mrs.
Dr.
First Name
*
Last Name
*
Primary Phone Number
Secondary Phone Number
Area Code
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Phone Number
*
Area Code
Phone Number
Primary Contact Email Address
Email Address
Primary Contact Address
Street Address
*
Address Line 2 (Your mailing address here if different than physical address, i.e. PO Box)
City
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State
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Zipcode
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Please briefly describe the Computing / IT services you need or any issues you may be having.
Please check off any of the following areas that best describes you and/or your business.
Personal computing/home user with PC or Mac.
Other:
Home Based Business with 10 or fewer users.
Other:
Small/Medium-sized Business with 20 or fewer users.
Other:
Commercial Enterprise with 20 to 50+ users.
Other:
What is the best method for contacting you?
Primary Phone
Secondary Phone
Email
When is the best time to contact you?
Immediately / ASAP
This Week
Next Week
Other (specify time and day)
Other: