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Request-A-Repair
11
Questions
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1
Full Name
*
This field is required.
First Name
Last Name
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2
Contact Number
*
This field is required.
Area Code
Phone Number
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3
Email Address
*
This field is required.
example@example.com
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4
Address for device Pick-Up
*
This field is required.
Street Address
Street Address Line 2
City
State
Zip Code
South Africa
South Africa
South Africa
Country
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5
Preferred Date for Pick-Up
*
This field is required.
-
Date
Year
Month
Day
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6
Device To Repair
*
This field is required.
Cellphone - iPhone
Cellphone - Google
Cellphone - Samsung
Cellphone - LG
Cellphone - HTC
Cellphone - Motorola
Cellphone - Blackberry
Cellphone - Nokia
Cellphone - Amazon
Cellphone - Oneplus
Cellphone - Sony
Cellphone - Huawei
Android Tablet
Apple iPad
Computer Screen
Laptop Screen
Game Console
Other
Cellphone - iPhone
Cellphone - Google
Cellphone - Samsung
Cellphone - LG
Cellphone - HTC
Cellphone - Motorola
Cellphone - Blackberry
Cellphone - Nokia
Cellphone - Amazon
Cellphone - Oneplus
Cellphone - Sony
Cellphone - Huawei
Android Tablet
Apple iPad
Computer Screen
Laptop Screen
Game Console
Other
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7
Device Model
*
This field is required.
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8
Service Required
*
This field is required.
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9
Optional Extras
Screen Protector
Phone Cover
Charging Cables
Screen Protector
Phone Cover
Charging Cables
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10
Additional Notes
Huge
Large
Normal
Small
Ok
quote
Created with Sketch.
Ok
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11
Payment Method (Upon Job Completion)
*
This field is required.
Cash
EFT via PayFast
Card Machine
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