SAMPLE

XYZ Charter

719 Fourth Street

Anytown, TX

555/555-1234

REQUEST FOR COMPUTER REPAIRS

Please list below any repairs that need to be made to your computer or printer.

Teacher: ____________________________________ Room #: ________________________

Item brand and model -- be specific: ______________________________________________

Full description of problem: ____________________________________________________

___________________________________________________________________________

___________________________________________________________________________

XYZ Charter

719 Fourth Street

Anytown, TX

555/555-1234

REQUEST FOR COMPUTER REPAIRS

Please list below any repairs that need to be made to your computer or printer.

Teacher: ____________________________________ Room #: ________________________

Item brand and model -- be specific: ______________________________________________

Full description of problem: ____________________________________________________

___________________________________________________________________________

___________________________________________________________________________

IV. 18