Appointment Confirmation & Client Agreement

Personal Information

E-Mail:*

Valid e-mail is required

First Name:*

Last Name:*

Address Line 1:*

Address Line 2:

City:*

State:*

Zip Code:*

Phone:*

Credit Card No.*

Expiration Date*

CVV or Security Code*

I agree to ALL Terms & Conditions of The Computer Specialists, LLC*

Digital Signature*

Billing Address if different from above

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