Name*:

Company:

Address Line 1*:

Address Line 2:

City, State, and Zip Code*:
PAALAKASAZARCACOCTDEDCFMFLGAGUHIIDILINIAKSKYLAMEMHMDMAMIMNMSMOMTNENVNHNJNMNYNCNDMPOHOKORPWPRRISCSDTNTXUTVTVIVAWAWVWIWY

Telephone Number*:

Email*:

Laptop Brand*:

Laptop Model*:

Laptop Serial Number:

 Is your laptop an international model?

Please provide any BIOS, system, or Windows login/password information required to access your laptop*:

Please provide a detailed description of the problem you are experiencing, if possible recreating step-by-step what caused the problem to occur*:

Is the laptop still under warranty*:
[radio* warrantystatus "In Warranty" "Out of Warranty" "Unsure"]

Date laptop was purchased*:

DPD Computer Center is a certified warranty repair center for Toshiba systems. For all other brands, we can perform the repair under the warranty period, but full labor and parts charges will apply.

In addition to your primary repair service, if you would like a quote on additional upgrades to your laptop, please check all that apply:
 CD-RW Drive DVD/CD-RW Combo Drive Memory Upgrade Operating System Upgrade DVD Drive Hard Drive Upgrade Keyboard Replacement

Please include your AC Adapter and Power Cord with your laptop to avoid possible delays in your repair. Please select all of the following items which are being shipped with your laptop:
 AC Adapter and Power Cord Battery External Floppy Drive External CD-ROM / DVD Drive External Hard Drive Carrying Case Software/Restore CD (required if you want us to restore your OS or other software) Other

If "Other" from above, please indicate what additional unlisted items you are shipping:

 I understand that DPD Computer Center is not responsible for any software or data lost on my hard drive. I am responsible for backing up the data on the hard drive prior to shipping the unit to DPD Computer Center for repair.

 I understand that DPD Computer Center is not responsible for any damage caused to my laptop during shipping to and from our location. I am responsible for notifying DPD Computer Center to add insurance and for covering the additional insurance expense.