Tech-N-Go Emergency Service Request Form

If your Service Request does not require Emergency - Immediate Assistance, Tech-N-Go recommends you use our regular Service Request Form by clicking here.

Please use the form below:

" Indicates a required field.

First Name:

Priority Code Pricing

4 - Emergency - Immediate assistance (Rate $140 hr.)

Minimum 1 Hour - Service Call (4 Hour Minimum during Non Business Hours).

NOTE: Travel Time:
Service within 20 miles radius included.
Tech-N-Go will travel further for an additional fee.

Last Name:

Email:

Company:

Address:

City:

State:

Zip Code:

Day Phone:

- -

Extension:

Night Phone:

- -

Extension:

Emergency Service Request
(Please type a detailed description of the service
you are requesting.)

Select
Priority Code

	4

Any additional information or questions to help us serve you better?

Authorize Service:
Please type the word YES in the box below to authorize Tech-N-Go to perform the above requested services:

Note: You will receive a copy of your Service Request form via the e-mail address entered above.

Please note that all contact information will be kept confidential and will not be sold or released. (Please see our Privacy Policy for more information.)


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