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Requested Information

Company/Institution Name (if applicable)

Your Name *

Email *

Phone Number *

Have you spoken with a Gateway Technician regarding this issue?

Yes

No

If yes, whom?

Helpful, but Not Required Information

Do you have a service contract with Gateway?

Yes

No

Unsure

Onsite Contact Name (if different)

Onsite Contact Email (if different)

Onsite Contact Phone Number (if different)

Site Address

City

State

Zip

Reported Issue *

If you have any relevant pictures, videos, or files, please attach here.

Do you have preferred days and/or times for an onsite service call? (Not guaranteed)

Yes

No

Preferred Day and/or Times

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Service Request