Repair-A-Pod Customer Information Form
Welcome to Repair-A-Pod’s customer information form. Fill the information below to begin the repair process, obtain a quote, and give us details to assist you better.

Repair-A-Pod specializes in the repair and renewal of broken/damaged Androids, iPhones, iPads, iPods, Computers, Tablets, Digital Cameras, and more!

*Please Note: Some parts are ordered per customer and usually arrive within 2 business days. Part expenses are due upfront, and labor is due afterwards. You may also opt to pay in full upfront and save 5% on your repair. For CASH payments, you will need to meet with a repair technician to pay. For CARD payments, you may visit: or “CashApp” $repairapod
*Extensive mileage repair trips will incur a transportation fee.


Personal Information
This section gathers information on the customer in need of repair.
First Name *
Your answer
Last Name *
Your answer
Gender *
*We ask this question to help technicians identify you when meeting for repair, and address you respectfully.
Your Phone Number *
Enter Your Phone Number
Your answer
Backup Phone Number *
Enter A Phone Number You Can Be Reached At If Your Phone Is/Becomes Inoperable. Otherwise, enter “None”
Your answer
Current City *
Your answer
Current State *
Your answer
Email *
Your answer
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