METROGEEK Customer Resolution Form

 
First Name :: Please enter your first name. This is a required field.
 
Last Name :: Please enter your last name. This is a required field.
 
Company :: If applicable, please enter the company name
 

:: Please check here if residential or home service
 
E-mail :: Please enter your e-mail address. This is a required field.
 
Phone # :: Please enter your telephone number in the event we need to contact you. This is a required field.
 
Fax # :: Please enter your fax number
 
Address Line 1 :: Please enter the first line of your address. This is a required field.
 
Address Line 2 :: If needed please enter the second line of your address
 
 
 
 
Date of Service :: What was the last date of service?
 
Service Ticket or DID # :: What was the service ticket or dispatch id #
 
Technician(s) :: Please enter the name of technician(s) who last provided you with service
 
Complaint Requiring Corrective Action :: Please describe the problem you have that needs correction
 
Originally Expected... :: When I requested service, I originally expected what...
 
Suggested/desired resolution? :: What type of resoution are you expecting or desire?
 
 
To help prevent spammers from abusing our forms and sending email to other people as if it came from us we have implemented the Captcha Image System. Please enter the letters, numbers and/or symbols exactly as they appear.
 
  
Verification :: To help prevent spammers from abusing our forms and sending email to other people as if it came from us we have implemented the Captcha Image System. Please enter the letters, numbers and/or symbols exactly as they appear.