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Velocita Service Call On-Line

To request service from Velocita Technology, Inc. please complete this online form. A Velocita representative will contact you before the requested services are performed.

Business or Personal Name *

If a busines is requesting service please enter the name of the business. If you are a consumer requesting service, please enter your first and last name.
Contact Person

If a business is requsting service please enter the name of the person will be Velocita's contact when performing this service request.
Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country

Please provide us with your billing address.
Phone ### - ### - ####
Please provide a phone number to contact the "contact person" stated above.
Email *

Please provide an email address to contact the "contact person" stated above.
Product Requiring Service -- Including Manufacturer, Model Number, Serial Number and Product Description *

Please enter the product that is requiring service. Please provide as much of the requested information as possible. If you are unable to locate any of the requested information please at least input the manufacturer name at a minimum.
Problem Description; Please be as Detailed as Possible. *

Please enter the nature of the service requested. Please provide as much detail as possible to assist your representatives in understanding your issue.
Service Type *
On-Site Service Carry-In Service Velocita LiveSupport Remote

If you desire this service request to be performed at your location by a Velocita service representative please select On-Site.
If would like to bring the item requiring service to our service facility located in Joliet, IL please select Carry-In Service.
If you are having a software problem and would like to have a Velocita Technology service representative remotely repair your issue using a high speed internet connection, select Velocita LiveSupport Remote.
Priority of Service Desired
Please enter the urgency of this service request here. Would you like this service to be performed during normal business hours? Would you like this service to be considered an emergency? Extra charges will be encurred outside of normal business hours.

Please enter your expectations of how soon you would like this service to be performed. Service is available 24 hours per day however extra charges will be incurred outside normal business hours.
Do Not Fill This Out