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2. Your Name*
3. Problem is with*

   1. hardware
   2. software
   3. phones

   1. website
   2. databases
   3. something else
4. Located Where
6. Specific Hardware / Software
   Please include the inventory tag number or the serial number of the hardware having problems.
7. Repair Priority

   1. Low (3-5 days)
   2. Medium (1-3 days)
   3. High (fix immediately)
9. Reporting Date
10. Time
14. What exactly is the problem?*

    Please give details!

16. When did the problem start?
17. Has it worked before?
18. When was the last time it worked?
20. What has changed since it worked?
22. Did you get any error messages? What were they?
24. What other programs were open?
26. Attachment
    Attach a screenshot or other file to help explain the problem.
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28. 1. Receive an email copy of this form.
29. Email address

    This field is not part of the form submission.

30. Submit

* indicates a required field