Web
Form
Supreme Online Service Request
Fields marked with
*
are required.
Type of Service You Need
*
Customer Site Service Request (CSSR)
Walk-In Appointment at Supreme's Workbench (Express Service) (WIA)
Customer Name
*
Contact Person
*
Contact Number 1
*
Contact Number 2
E-mail Address
Customer Address
Directions To Customer Place if CSSR
Equipment Brand
Equipment Model
Equipment Type
*
Problem Experiencing or Service Required
*
Type of Service Required
*
Diagnostic Report + Estimated Cost of Repair
Proceed to Complete Repair Solution Immediately
Complete Repair If No Parts Are Required
Date you wish to bring in your Equipment
Date You would like us to visit your place
Is it OK to contact you with the information provided when we have promotions
Yes
No
Select a Free Gift you would like after Completion of Each Service Process
8 Gig Flash Drive
Head Phone Set
8 Gig MicroSD Card
(new option)
Car Cellphone Charger
Web
Form
Service Provided by
Doteasy Web Hosting
for
SUPREMEGRP.COM
