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9045 La Fontana Blvd #227, Boca Raton, FL 33434

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24 Hours by Appointment

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Home
Our Services
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About us
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- Contact Us
- Request A Quote

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Contact us

(561) 877-1119

Available

24 Hours by Appointment

Make An Appointment

Home
Our Services
Remote Support
Meet the Owner
About us
Contact
- Contact Us
- Request A Quote

Home
Our Services
Remote Support
Meet the Owner
About us
Contact
- Contact Us
- Request A Quote

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Intake Form

Home » Intake Form

Choose One*
- Business
- Residential
EXISTING CLIENT?
- YES
Technician*
Client Name/ID*
TeamViewer ID
Windows Password
Other Password (WiFi, etc)
Basic Information
Phone Number
Email
Intake & Issues
Type of Computer
Special Tag / Model #
Overview / Diagnosis*
Explain ALL Issues*
Assigned Agent*
Services Needed
Primary Services (CHECK ALL THAT APPLY)*
- PC Cleanup
- Virus Related
- Install Programs (See Below)
- Software Diagnostic
- Hardware Diagnostic
- Part Need Ordering (See Below)
- Format / Reinstall
- Random Crashes / BSOD
- Data Needs Backup
- Activation of Product/s
- Misc. SERVICE Needed (See Below)
ADDITIONAL SERVICES REQUESTED
Additional Information
Choose Any That Are Needed*
- NOTHING IS NEEDED
- Freemium Programs
- PRO/Premium Antivirus
- Business Antivirus
- Windows 7 OS
- Windows 8.1 OS
- Windows 10 OS
- Office 2007
- Office 2010
- Office 2013
- Office 2016
- Brilliant Drive
- Other Program (explain below)
Other Program*
NEED A PRODUCT ORDERED?
PRICE REQUEST / ORDER FORM
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Max. file size: 100 MB.

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Brilliant Computers has been serving the Boca Raton and surrounding communities in Palm Beach and Broward County for over 35 years. Contact us today for Peace of Mind Computing!

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Our Services

Home
Our Services
Remote Support
Meet the Owner
About us
Contact
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- Request A Quote

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