In-Home Service Booking Assistant

Customer Information:

Name: *

Primary Phone Number: *

Alternative number (optional):

E-Mail (optional):

Address: *

City: *

Postal code: *

In-Home Service Details:

Service Request: *

Primary device service: *

WARNING - Additional handling required

TV Mounting: *

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: *

Is product being delivered to client address? *

Technician confirmation required Only book a specific time after a technician has verified availability. I have confirmed this appointment time with the technician.

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:

Additional time:

Distance fee:

Subtotal:$0.00

Tax (12%):$0.00

Total:$0.00

For Invoicing:

x__ - _____

Attach receipt copy to printed paperwork and/or SVO.

Payment method: *

Invoice number:

Please inform client that payment in home is cash-only at this time.
Mobile debit/credit is unavailable.

Staff Initials: *

Be sure to confirm you have copied the summary into Ontrack before clearing or refreshing the page.
No personal data is saved and this form cannot be restored once cleared.

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

Please print and provide copy to technician.