Estimate Request – C&C Instrument Care

Pickup Location *SchoolACIS IT SolutionsOther

Desired Pickup Date

Desired Repair Completed by Date

Service Request Type *Need EstimateJust Fix It

Select Your City/Town *

Name of City/Town *

Pickup Location *Name of school, ACIS IT, or address.

ACIS Employee EmailPlease enter an email to receive a copy of this form

Customer First Name *

Customer Last Name *

Customer Email Address *

Customer Phone Number *

General Notes — Optional

Method of Entry For Instrument DetailsEnter Manually On FormUpload a file with Instrument Details

Instrument Details

Instrument Type *

Other Instrument Type *

Instrument Make *Yamaha, Selmer, King, and etc…

Instrument Model *

Serial Number *Enter “Not Found” if a serial number cannot be found

Repair Request Description *0 / 200

Instrument Pictures

Optional — Upload pictures to help expedite the estimate process

Upload file *

No file chosen

Upload Any file type that has your instrument details