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Service Request Form

"*" indicates required fields

Your Name*

First Last

Your Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Your Phone*

Your Email Address*

Type of Service*

Type of Request*

Brand of Phone*

Make & Model*

Phone Condition*

Any known water damage?*

Yes

Has the phone been previously serviced for this issue?*

Yes

Access Password*

Media Type*

Brand and model*

Capacity

What happened?*

What lost files are you trying to recover?*

Send-in method*

How did you hear about FlashFixers?

Additional Comments

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