APPOINTMENT REQUEST (P)Fusion Intellect
Today's Date: Current Time: Request Your Appointment Now!
1) Will this be your first time receiving services from (P)Fusion Intellect ? Yes No
2) Where is your desired service location? My Home Friends Home Hotel Corporate Office Retail Location Religious Facility Other/Special Event
2a) Is This Donation For E-waste Reuse & Reycle Pick-Up? To sell your items click here. Note: All items you want to sell will not have a value. Donate them instead of adding to landfills. Yes No
2b) Please describe & list the items for reuse & recycle pick-up:(electronics only) (Please be specific and list each item being donated. Select the approximate weight below.)
2c) What is the approximate (total) weight of the E-waste items for pick-up? 1-20 pounds 21-50 pounds 51-100 pounds 101-350 pounds 351-500 pounds Need A ForkLift Not applicable
3) Address for service/ E-waste pick-up: (Please be specific and list closest intersections. If this is for E-waste pickup, please indicate if this is a large package above.)
If you are donating E-waste (ONLY) click the request button below.
4)Which service('s) are you requesting? (you may select more than one service by clicking on additional checkboxes.) Computer Services: Hardware/Software Installation Computer Diagnostic Computer Repair Virus & Spyware Removal Operating System Upgrade RAM- Memory Upgrade New Computer Build New Laptop Build Special PC Case Modifications System Security Analysis (Data Recovery rates are $50-75 each hour.) Data/Password Recovery Microsoft O/S 1 Hour $75 1½ Hour $112.50 Data/Password Recovery Apple O/S 1 Hour $75 1½ Hour $112.50 Data/Password Recovery Linux/Unix O/S 1 Hour $50 1½ Hour $75
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5) How many rooms/offices will you need Emersion PC systems installed? 1 Room/1 Emersion PC 2 Rooms/Emersion PC's 3 Rooms/Emersion PC's 4 Rooms/Emersion PC's 5 Rooms/Emersion PC's 6 Rooms/Emersion PC's 7 Rooms/Emersion PC's 8 Rooms/Emersion PC's 9 Rooms/Emersion PC's 10 Rooms/Emersion PC's 11 Rooms/Emersion PC's 12 Rooms/Emersion PC's 13 Rooms/Emersion PC's 14 Rooms/Emersion PC's 15 Rooms/Emersion PC's 16 Rooms/Emersion PC's 17 Rooms/Emersion PC's 18 Rooms/Emersion PC's 19 Rooms/Emersion PC's 20 Rooms/Emersion PC's 21 to 29 Rooms/Emersion PC's More than 30
6) Are LCD TV's or Projectors Needed? Yes No
7) Are surge protectors used in each room/office? Yes No
9) Emersion Technology Software Installation (Only)? Yes No
10) Are you making reservations for In Home Consultation only? Yes No
11) Are you making reservations for a Not For Profit Organization? Yes No
12) If 'yes' to question 10, how many participants? 1 Participant 2 Participants 3 Participants 4 Participants 5 Participants 6 Participants 7 Participants 8 Participants 9 Participants 10 Participants More than 10
13) Any specific property access conditions or limitations we should be made aware of? Yes No If you answered 'yes' please provide a detailed explanation in the box below: (If you reside in an apartment or gated community please explain entry process.)
15) How were you referred to (P)Fusion Intellect ? If a registered (P)Fusion Intellect consultant referred you to this website, please type their referral number and name below: Referral# Consultant:
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17) Enter any promotional (coupon) codes here:
Have additional questions,comments, or special accommodations? Enter them below:
