What Service Do You Need? *

💻 Computer & Laptop Repair 🛡️ Virus Removal & Security 📶 Network & Wi-Fi Setup ☁️ Microsoft 365 & Cloud 🌐 Remote IT Support 💾 Data Recovery & Backup 📷 Smart Home & CCTV 🔧 Other IT Service

2

Your Details

Full Name *

Phone Number *

Email Address *

Business Name (optional)

Suburb / Area

Preferred Contact Method

Best Time to Contact

How did you find us?

First time customer?

3

Device Details

Device Type *

Brand / Make *

Model Number (optional)

Serial Number (optional)

Operating System

Approximate Age of Device

Device Password / PIN (optional — only if needed for repair)

Is device still under manufacturer warranty?

Has anyone else attempted repair?

Accessories Included Charger / Power Adapter included

Other Accessories (optional)

3

Network Details

Property Type

Internet Provider (ISP)

Router / Modem Brand

Number of Devices to Connect

3

Microsoft 365 Details

Number of Users / Staff

Current Email Provider

Do you have an existing Microsoft 365 licence?

What do you need set up?

3

Data Recovery Details

What happened?

What data needs recovering?

How important is this data?

4

Problem / Issue Description

Describe the problem in your own words *

0 characters � minimum 20 recommended

How long has this been happening?

5

Device Condition

Overall physical condition *

✨ Excellent No visible damage 👍 Good Minor marks only ⚠️ Fair Noticeable damage ❗ Poor Significant damage

Additional damage notes (optional)

6

Upload Photos (optional — up to 5 photos)

📸 Upload photos of the damage, error messages, or serial number sticker. Max 5MB per photo. JPG or PNG only.

📁

Click to upload photos

or drag and drop here

7

Service Preferences

Urgency *

Service Location *

Preferred Date (optional)

Preferred Time Slot

Budget Range (optional)

8

Declarations & Signature

Terms & Conditions Summary

No Fix No Fee: You only pay if the repair is successfully completed.
Data Loss: We are not responsible for data loss. Please back up all data before submission.
Free Diagnosis: If you choose not to proceed after assessment, no charge applies.
14-Day Guarantee: Same fault within 14 days — we fix it free.
Uncollected Devices: After 30 days storage fees apply. After 90 days device may be disposed of.
Privacy: Your information is protected under the Privacy Act 1988 (Cth).
Electronic Agreement: This submission is legally binding under the Electronic Transactions Act 1999 (Cth).

Read full Terms & Conditions | Read Privacy Policy

✅ I declare that I am the legal owner of this device or have explicit authority from the owner to authorise this repair. I understand that providing false information is a criminal offence under Australian law. ✅ I confirm that I have backed up all important data. I understand NextGen Tech Solutions is not liable for any data loss during the repair process. ✅ I have read and agree to the Terms & Conditions and Privacy Policy. I understand this is a legally binding electronic agreement. ✅ I consent to NextGen Tech Solutions collecting and using my personal information to provide repair services as described in the Privacy Policy. 📧 I'd like to receive IT tips and special offers from NextGen Tech Solutions. (optional — unsubscribe anytime)

Your Signature *

By typing your name you confirm this is your electronic signature under the Electronic Transactions Act 1999 (Cth).

🔒 Secure submission. Your IP address and timestamp are recorded. This form cannot be edited after submission. A copy will be emailed to you immediately. This record is legally admissible under the Electronic Transactions Act 1999 (Cth).

🔒 SSL Encrypted | 🇦🇺 Privacy Act 1988 Compliant | ✅ Electronic Transactions Act 1999

Device & Service Intake Form