Support Ticket
 

Please fill out the form below for Support.  Once you have completed this form you will be taken to our sales cart where you can pay with credit card, an online secure check or to be billed.  Make your selections and complete the sales cart forms.  Thanks, we are glad to have you as our new customer

Information

Please fill in the box below with a brief description of support request.
  

      
METHOD OF PAYMENT
Required:
Payment Method:

DOMAIN NAME
Domain: (Please include the .com, .org, or .net at the end.)
(lower case)
CONTACT INFORMATION
Name:  (First, Last )


Company:


Street:


City:  State:  (2-letter abbr)

Zipcode:  Country Code:  (2-letter abbr)

Phone:  Fax Number: 

Email:  REQUIRED!
BILLING CONTACT INFORMATION - IF DIFFERENT THAN ABOVE
Name: (First, Last )
 

Company:


Street:


City:  State:  (2-letter abbr)

Zipcode:  Country:  (2-letter abbr)

Phone:  Fax Number: 

Email:  REQUIRED!
  
TERMS OF SERVICE
Please read before continuing:
By submitting this form, I understand I am requesting Compu-Wise to consult with me on items listed above. 
Please be patient! Click ONCE only. Your order is being forwarded to our sales office and you will be transferred to a payment option form. Please make a note of the total amount. Thanks.
 

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