Computer Repair Form
Person Completing Form
Email Address
Room Number
Date
Printer Make and Model Number
Ink Cartridge Number
Quantity
Please indicate quantities needed and any additional information in the box below.
0 1 2 3 4 5 CD-R
0 1 2 3 4 5 Batteries
0 1 2 3 4 5 Patch Cables
0 Boxes 1 Box 2 Boxes 3 Boxes 4 Boxes 5 Boxes Floppy Disks
Other - Please describe below
