Name: _______________________________________ ( NO PO BOXES) Address:_____________________ City:___________________ Zip:_________
Type of device: iPhone____Samsung_____ PC// Mac Screen Color_______
Cost: $_____
Password: __________________ IMEI / MEID #_____________________
Phone # ______________________ Alternate # ____________________ Email ___________
Reason for repair: (Please circle all that apply) Cracked LCD Screen / Home Button / Front Camera / Back Camera / No Signal /Battery Issues / Charging Port / Viruses /Back Cover / Screen Protector / Audio Jack / Boot Loop / Start up Issues / Water Damage / Power Button Issues / Wifi / Volume Button / Sound / Phones Slow /
Other_________________ Phone / Tablet is off due to low battery / defective battery / cracked LCD (Screen) _________ initial here
By signing below, I authorize EZ Tech Wireless technician(s) to perform repair work on my electronic device.
I understand that EZ Tech Wireless technician(s) have been trained to perform work on electronic devices but EZ Tech Wireless technician(s) are not an authorized service dealer. I agree to release, indemnify, and not hold EZ Tech Wireless for liability for any claims or damages of any kind or description that may arise from any repair work performed on my electronic device. I understand that EZ Tech Wireless is not responsible for any data loss, which may occur as a result of work done on my electronic device.
I also understand that I have the option to, and I am responsible for backing up the device before allowing any repair to be performed on my device in the event of any data loss and hardware or software failure.
**** iPhone 6S to 8+ series, iPhone X / XS / XR / XS MAX LCD/Digitizer repair may cause the Fingerprint Sensor/Home Button / Face ID to become inoperable due to an Apple Firmware compatibility**** A Green Line may appear down the middle on iPhone X / XR / XS / XS Max due to iPhone Hardware known issues. Ez Tech Wireless will not be held responsible for this malfunction. Proximity sensor may become damaged depending on how cracked the screen may be.
I understand that EZ Tech Wireless will not browse through any personal, private or confidential information or data; however, technicians may inadvertently see data during the course of their work. I understand that any confidential data should be removed from the device prior to having repair work performed on the device. The password or pattern code must be available or deactivated upon repair to mobile device. I agree to pick up my device within 5 days after I am informed of my repair is done and or diagnosed. Customer abandonment of any electronic device, computer, tablet, cell phone occurs within 5 days.
I understand that repairs or technical support performed by EZ Tech Wireless may void manufacturer warranties, especially in the case of iOS device repairs. EZ Tech Wireless and its affiliates do not assume any liability or warranty in the event that the manufacturer warranties are voided but may, at its sole discretion, offer its own warranty on the parts and/or services performed. We offer a 90 day warranty on all repairs as long as the receipt is present. Warranty does not cover cracked glass or water damage to device. EZ Tech Wireless will not be responsible for any devices left at our facility for more than 5 days without contact, this will be known as customer abandonment.
Signature ____________________________________________ Date: _______________