Check-in Form Check In Form Checking in a computer / device for repair in store. Date* MM slash DD slash YYYY Customer Type*ResidentialBusinessBusiness Name Client Name* First Last Phone*Alt Phone Email* Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code How many devices?*1 Device2 Devices3 DevicesHow many devices/computers do we need a form for.1st DeviceType* Make* Model* System Password Peripherals Includes AC Adapter? Includes addtl Software? Includes addtl Hardware? Addtl Software Addtl Hardware Under Warranty?*NoYes2nd DeviceType* Make* Model* System Password Peripherals Includes AC Adapter? Includes addtl Software? Includes addtl Hardware? Addtl Software Addtl Hardware Under Warranty?*NoYes3rd DeviceType* Make* Model* System Password Peripherals Includes AC Adapter? Includes addtl Software? Includes addtl Hardware? Addtl Software Addtl Hardware Under Warranty?*NoYesServices Requested General Cleanup Virus Removal Software Repair Hardware Repair General Troubleshooting Data Recovery Software Upgrade Hardware Upgrade Repair Notes*By initiating a service call, in-store or on-site, I acknowledge that support services provided by Mitec Solutions LLC. may result in malfunction of certain programs or functions of my personal computer, networking equipment or peripherals and that this may occur through no fault of Mitec Solutions LLC. Knowing and understanding the risk of accepting the support services of personnel of Mitec Solutions, LLC, I affirmatively forever release and hold harmless Mitec Solutions LLC., its owners, employees, and vendors against any loss, liability, or damage that you or the owner or lessee may suffer including, but not limited to, any loss of any data or the non-functioning of any component or element of my computer equipment, networking equipment or peripherals regardless of any warranties, disclaimers and waivers. Furthermore, I agree in advance to release, waiver, forever discharge, and covenant not to sue Mitec Solutions LLC., any of its employees, officers, or agents from and against any and all liability for any harm, injury, damage, claims demands, actions causes of action, costs, and expenses of any nature that may result from support services I accept for my personal computer. Mitec Solutions reserves the right to hold all computers and equipment until the customers open balance is paid in full. A 1.5% finance charge will be applied every 30 days to all open balances. Any hardware or software left for over 90 days will be disposed of. In any legal dispute the non-prevailing party shall pay all fees, including court and attorney fees of the prevailing party. I understand I will be charged a minimum of 1-hour labor whose rates are defined by Mitec Solutions.Signature*