Customer Information

Full Name Email Address Phone Number Preferred Contact Method — Select — Email Phone Either

Device Identification

Make / Brand Model Serial Number IMEI (if applicable) Storage Size Colour

Device History

Has the device been repaired before? — Select — Yes No Not Sure If yes, what was repaired? Has the device been opened before? — Select — Yes No Not Sure

Insurance Details

Is the device insured for the inbound journey? — Select — Yes No Unsure Amount insured during transit (£) Market value (£) Is this repair under an insurance claim? — Select — Yes No Insurance Company Policy Number Claim Reference Has the device been repaired under insurance before? No Yes Unsure If yes, approximate date What was repaired? Result of previous repair Successful Failed Temporary Unknown Return‑shipping insurance responsibility Green Tech Repairs (Platinum Tier) Customer (Silver / Gold) Insurer (If claim)

Symptoms & Fault Description

Describe the issue(s) When does the issue occur? What have you tried so far?

Backup Status & Details

Has the device been backed up? — Select — Yes No Not Sure Last backup date Backup method Backup destination Backup issues

Software Environment & Critical Apps

Operating System Version Critical apps Business‑critical software Antivirus installed Startup programs Software that must NOT be removed Software that must NOT be updated

Liquid Damage Disclosure

Has the device ever been exposed to liquid? — Select — No Yes Not Sure If yes, what type of liquid? When did this occur?

Liquid Metal Disclosure

Has liquid metal ever been applied? No Yes Unsure When was it applied? Who applied it? Brand / Type Any leakage? No Yes Any corrosion? No Yes Overheating since application? No Yes

Battery & Power Safety

Is the battery swollen? No Yes Not Sure Does the device overheat? No Yes Intermittent Does the device shut down unexpectedly? No Yes Intermittent

Physical Condition on Arrival

Green Tech Repairs will video‑record and photograph your device and its packaging the moment it arrives via courier.

Visible Damage Missing Parts Packaging Condition Pre‑existing cosmetic issues?

Sensitive Data Declaration

Does the device contain sensitive data? No Yes Unsure Folders we must NOT open Business‑critical data present? No Yes Encrypted partitions? No Yes

Permissions & Consent

Permission to open the device? — Select — Yes No Permission to run diagnostics? — Select — Yes No Permission to wipe the device? No Yes Only if required Only after contacting me Permission to update OS? No Yes Only if required Only after contacting me Permission to back up? No Yes Permission to reinstall OS? No Yes

Device Handling Process

• Checked in on arrival
• Assigned to a qualified technician
• Documented before any work begins
• Protected and stored securely during repair
• Quality‑checked before return
• Packaged by a dedicated dispatch technician

GDPR‑Compliant Data Handling

• No browsing of personal files
• No access to photos or messages
• No access to business data
• GDPR‑compliant handling
• Encrypted storage if required

Customer Expectations & Boundaries

What outcome do you want? What do you NOT want us to do? Urgency Level Standard Urgent Critical Special Instructions

Agreement, Signature & Date

By signing below, you confirm all information is accurate and authorise Green Tech Repairs to proceed with diagnostics and approved work.

Full Name (Signature) Date I confirm I have read and agree to the terms of this repair intake.