Service Intake Ticket

Thanks for choosing 365 Gadget Revival! Please fill out this form before drop-off. You'll receive a confirmation email with drop-off instructions, followed by a pre-invoice with a suggested service timeframe once we've reviewed your device.

Customer Information

Name

Phone

Email

Device InformationDevice InformationPhoneTabletLaptopDesktopXboxPlaystation

Brand

Model

Serial #

Reported Issues / Symptoms

Condition on ArrivalCondition on ArrivalCracked ScreenPhysical Damage Liquid Damage Won't Power OnBattery IssueVirus / MalwareOther

Additional Notes

Service RequestedService RequestedScreen RepairBattery ReplacementPort RepairData TransferOS ReinstallDevice CleaningDevice RefreshOther

Consent and Authorization Consent and Authorization I authorize 365 Gadget Revival to diagnose and repair the device(s) listed above.I acknowledge I am liable for any lost personal data resulting from service.

365 Gadget Revival is not responsible for data loss, pre-existing damage not noted above, or issues arising from third-party parts. A diagnostic fee may apply if repair is declined after evaluation.

Signature

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