New Repair Note

1 Customer Details

Customer Name * Phone Location Alt. Contact

Phone Laptop Monitor Printer Other

Brand Model No. Serial No. Color Other (specify)

Overall Condition

Good Fair Poor

Photos Taken

Yes No

Accessories Received

Rider (Pickup) — Name Rider Number Pickup Date / Time Customer Signature (type full name)

I confirm the device condition and fault description above are correct at drop-off.

Date / Time Received at Workshop Branch / Location Technician Assigned

Diagnosed Fault (may differ from reported fault) Parts Needed

Customer Approval

Signed Approved via Call/WhatsApp

Estimated Cost Approval Date

Date	Work Performed	Parts Used	Cost

Total parts/labour: 0.00

Repair Started Est. Completion

QC Technician Date Tested

Result

Tested OK Needs Rework

Warranty on Repair (days)

Amount

Method

Cash M-Pesa Card

Status

Paid Balance Due

Rider (Return) — Name Rider Number Return Date / Time Customer Receipt Signature (type full name)

I confirm I have received my device back and am satisfied with the repair.