IT Service Request Form

Please complete the following form with as much information as possible. 

An ICS Support Technician will be contacting you shortly regarding your request. 

 

Please Note:

If your request is for new consulting work, supplies, sales, or is not break/fix related

please DO NOT use this form.  Instead, click here to send an e-mail to our sales

department and to avoid any delays in processing your sales request.

Please provide the following contact information:    

Fields in Orange are required     

Company Name 

 

Authorized Contact Name 

 

Authorized Contact E-Mail   

Branch Location 

 

Contact Method Notes

(Please provide the phone number, extension,  e-mail address or Yahoo ID you wish to be contacted at) 

 

Please provide as much information as possible, including a contact phone number,

extension, and employee location.   The more information you provide the quicker

we can respond to, and resolve this issue.   Thank you for your cooperation.

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Please describe the problem you're having:

Problem/Issue Description  
Please give us a brief description of your issue  
Computer Name

 

Required Field.  If you don't know your computer name click here and click "Run" twice when prompted

User Name

 

Password

 
Importance  
 

Severity

Description                                                                                ETF

MINOR

Minor - A condition occurred that does not currently impair service, but the condition needs to be corrected before it becomes more severe.

MAJOR

Major - An alarm condition occurred, impairing a localized service  

CRITICAL

Critical - An alarm condition occurred that seriously impairs company wide service and requires immediate correction.

 

PLEASE MAKE SURE ALL THE REQUIRED FIELDS ARE COMPLETED BEFORE CLICKING SUBMIT. 

INCOMPLETE FIELDS WILL RESULT IN DELAYS IN ATTENDING TO YOUR PROBLEM.