Customer Info Customer Info (Pre-repair)First NameLast NamePhone NumberEmailDevice InformationBrand/Model (Include Model number as well):IMEI/Serial Number (optional):Carrier (if applicable):Color :Deposit for Special Order Parts (if applicable):In case your repair requires special order parts, a non-refundable deposit may be required to proceed with the order.Deposit Amount:Remaining Balance :Total Repair Cost (including parts and labor):Device DetailsAre you able to unlock the device and check the functionality? Yes NoNote: If we are unable to unlock the device and check its functionality before the repair, Fix 'N Repair is not responsible for any issues with the device’s functionality after the repair is completed, except for the repair we performed.Tech Notes : (Be sure to note any features that aren’t working or if there is any damage to the device. Include details about what functions were tested and any issues found)Repair Details:Issues with device: Cracked Screen Battery Issue Charging Port Problem Camera Issue Button Malfunction Broken Back Water Damage Software Issue No Power OtherIf you choose "Other", explain the problem:Has the device been repaired before?Are there any special instructions?Date / Time I have read and agree to the Terms and Conditions and Privacy PolicySubmit Form