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London Drugs Tech Services

Store 072 Education Session Assistant

Customer Information

Name: *

Primary Phone Number: *

Alternative number (optional):

E-Mail (optional):

Address (optional):

City (optional):

Postal code (optional):

Education Session Details:

Primary Request: *

WARNING - Additional handling required

Additional Details: *

TV Mounting: *

We can only install TVs to existing wall mount hardware. We are unable to install NEW wall mount hardware due to licensing restrictions.

Select any additional device setup for this service:

TV Addons

Soundbar Stereo/Receiver Streaming Device Disc-Player Device Cable Box

Computer Addons

Printer Accessories for computer

Appointment Information:

Booking Time: *

Please only list a specific time if technician has verified availability first!

Appointment date and time

Date:

Time:

When is the client available for scheduling?

Available from:

Until:

(1 hour minimum; latest end 5:00 PM)

Days available:

day unavailable due to tech work schedule Monday Tuesday Wednesday Thursday Friday Saturday day unavailable due to tech work schedule Sunday

Preferred date: (Monday & Sunday unavailable)

Preferred time:

Service Fees:

Hourly:

Subtotal:$0.00

Tax (12%):$0.00

Total:$0.00

For Invoicing:

x__ - _____ x__ - _____

Attach receipt copy to printed paperwork and/or SVO.

Payment method: *

Invoice number:

Employee Name or Initial: *

This is a form only. Data is not stored or saved at any point. Be sure to confirm you have printed and/or copied before clearing or refreshing the page.

Create an SVO and copy the summary into the description field.

Please print and provide copy to technician.

Clear all form data? You can confirm in 3 second(s).

Education Session Assistant Version 1.0

Created by Jason H for use at Store 072