Name:
       Company:
         Email:
       Address:
          City: St: Zip:
 Daytime Phone:
 Evening Phone:
           Fax:

  Product Type: System Unit/CPU Storage Device Printer Scanner Display/Monitor Operating System Other Don't Know
  Manufacturer: Model:
  Purchased On:      Purchased from: WRK Computer Systems Mail Order Department Store Computer Store (other than WRK) Other/Don't Know
    Serial Num: Operating System: Windows 3.x Windows 95 Windows 98 Windows NT 3.x Windows NT 4.x Mac OS Novell Netware 3 or earlier Novell Netware 4/IntraNetware Novell Netware 5

Problem Description (please be as detailed as  possible):

Best time and method to contact  you
 Morning   Afternoon   Evening
 Daytime Phone  Evening Phone  Fax  Email  Snail Mail