Use this form to arrange PC-Spa treatment for your computer.  (If you prefer, you can call us at (323) 851-4615. We can pick it up and deliver your PC anywhere in the Los Angeles area within two business days. Your Contact Information Your Name Company Name Street Address Address (cont.) City State/Province Zip/Postal Code Phone FAX E-mail Schedule Pickup Desired Date As soon as possible or on this date and time (Mon-Fri only): January February March April May June July August September October November December   01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 2002 2003 2004 9am-12pm 12pm-3pm 3pm-6pm   PC-Spa Treatment Plan (Enter number of computers for each treatment in box at left )   Basic PC-Spa Treatment ($295) Deluxe PC-Spa Treatment ($395) Ultimate PC-Spa Treatment ($495)   BILLING Credit Card VISA MasterCard American Express Discover Cardholder Name Card Number Expiration Date Billing address above should match information for this credit card. Press the button below to send us your reservation.  We will call you to confirm.