Equipment Intake Form
| Intake ID | DFX-__________ | Date | __________ |
|---|---|---|---|
| Client / company | ________________________________________ | ||
| Phone / email | ________________________________________ | ||
| Device type | __________ | Brand / model | __________ |
| Serial / IMEI | ________________________________________ | ||
| Reported fault | ________________________________________ ________________________________________ | ||
| Accessories received | ☐ none ☐ charger ☐ cable ☐ battery ☐ case ☐ other: ________ | ||
| Visible condition | ☐ good ☐ scratches ☐ cracked ☐ liquid signs ☐ missing screws ☐ previous repair | ||
| Data important? | ☐ yes ☐ no | Power on? | ☐ yes ☐ no ☐ intermittent |
| Password / lock info | ________________________________________ | ||
Client confirmation
The client confirms that the information above is accurate and that they are authorized to submit the device for diagnostics or repair.
Client signature
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_________________________
Received by
_________________________
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