CRU - Service Intake Form

Ticket #:
Intake:
Name:
Address:
Address 2:
City:
State:
ZIP Code:
Phone #:
Email :
Problem Description:

the first 30 characters of the problem description are the ones used in the email subject Line 2 Line 3 line 4 Line 5 line 6 line 7 line 8 line 9

Priority:	1 Critical	2 Urgent
3 Normal	4 Low	5 Very Low

Device Type:

Desktop

Laptop

Service

Other

Other:

Device Description (Brand, Model etc.):

Serial #:

Password:

Signature:

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