Computer Service Request

1. Tell us how to get in touch with you:

School	Please Select From List... Brilliant Elementary Brilliant High Guin Elementary Hackleburg Elementary Hackleburg High Hamilton Elementary Hamilton Middle Hamilton High Marion County High Phillips Elementary Phillips High
Name
E-mail
Telephone

2. Program Type

    Please Select From List... Regular Education Special Education Title 1 Administration Accounting

3. Type of Request

    Please Select From List... Computer Hardware Software Network Peripherals

4. If this request is for computer service, please fill out the following information.  For any other requests such as software,  

    printers, etc... please skip this section and go to section 5.

Manufacture	Please Select From List... Southnet HP Dell HiTech Other
If other, please specify
Model Number
Serial Number

5. Describe the reason for this service request.  Please be very specific and detailed.  Any request with this field left blank will NOT

    be processed.