Company Name:
Contact Name:
Customer Phone: Include Extension
IM Screen Name:
EMAIL:
User ID: with Problem or contact
Device ID: with Problem
Device Type: Printer/ Terminal
Halt Type: RPG, User, Close, Shutdown
Did You Answer Halt: YES NO If so what option: 0 1 2 3 4 I G C Other
Date/Time:
Problem: Please Describe in Detail what happened
Please be specific!
Question: Please be as Detailed as possible.
If you must fax additional Information or screen images please reference the number in RED at the Left! This will allow us to match this request to the fax. Fax Number 815-788-0854. This will also act a tracking number for you to use to track your problem or question.
