JTEC Systems Inc.
121 Stryker Ln, Bld 30 Unit 9
Hillsborough, NJ 08844

(908) 874-5304 Phone
(908) 874-6685 Fax


_______________________________________________________________________________________
OFFSITE REPAIR INFORMATION FORM


CUSTOMER NAME __________________________________

Business Name __________________________________

Address       __________________________________

              __________________________________

Phone Number  __________________________________



Machine Brand __________________________________

Machine Type     -Tower-  -Laptop-  -Desktop-  

                        (CIRCLE ONE)


Describe Problem Below -------------------------