Name:	*
Your e-mail address:	*
Your daytime telephone number:	*
Best time to call:	*
Operating system:	Select Operating System Windows 95 Windows 98 Windows 2000 Windows XP Windows ME -- Mac OS 7 Mac OS 8 Mac OS 9 Mac OS-X (OS-10) -- Other *
	If Other, please enter here:
Type of computer (iMac, Compaq, etc):
Memory (RAM):	MB
Internet Connection:	Select Internet Connection Modem, 33.6K or less Modem, 56K v.90 DSL Satellite Internet Finowen wireless Wavecom wireless Network connection (ethernet wire) Don't know *
Description of Problem. * Please be as detailed and as specific as you can. We can help you best if we fully understand the problem you are having.
I am requesting an appointment to drop off my computer for service. I understand that there will be a charge for this service. NO      Yes, please contact me for an appointment Perhaps - please call me to discuss this problem

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