Technology Repair & Services Request Form Full Name * First Name Last Name Business Name (If Applicable) Email * Phone * (###) ### #### Preferred Contact Method * Call Email Text Device Type * Desktop/PC Laptop Tablet Smartphone Game Console Other Brand (If Known) Model Name or Number (If Known) Operating System (If Known) Does The Device Power On? * Yes No Sometimes Unknown Describe The Issue Clearly Below * While we take every reasonable step to protect your device and data, there is always a risk when working with damaged or failing equipment. In rare cases, an attempted repair may cause additional issues or reveal previously hidden damage. By sending your device to Heaps & Herbert Technical Integrations, you acknowledge and accept this risk. We are not liable for any data loss, worsening damage, or hardware failure that may occur during standard diagnostic or repair procedures. * I Understand Heaps & Herbert Technical Integrations is committed to providing safe, professional, and legal technical services. To remain compliant with industry standards and local regulations, we currently do not perform the following: Installing or distributing pirated software, operating systems, or license keys. Circumventing software protections (e.g., cracking programs, jailbreaking devices). Unlocking phones, routers, or devices in violation of carrier or manufacturer policies. Accessing, modifying, or retrieving data without proof of ownership or authorization. Any service that would violate local, state, or federal law. * I Understand Once we receive your device, a technician will review the issue based on the information provided. After inspection, we’ll send you a quote via the email listed above. No work on the device will begin until you sign the quote. If you decline service after review of the quote. You may schedule a date to ship your device to a return address. Please note you are responsible for shipping fees. * I Understand Thank you for filling out the form! You will receive a message from us on your requested form of contact. There we will discuss more details and any questions. We look forward to working with you! We Will Send You An Address To Send Your Items To In A Follow Up Email From HeapsHerbert@gmail.com