Contact Person:  Your Full Name  
Business or Organization Name  
Address   City    State   Zip 
Phone   Fax Number   Other 
Email Address   Website Address  optional
Contact person name where equipment is located   Phone
Address where equipment is located, If different from above
What are your business hours? 

Type of Equipment

         Printer Brand/Model    Serial #
                                                                                     I.D. Tag #  
 

         Printer Brand/Model    Serial #
                                                                                     I.D. Tag # 
 

         Printer Brand/Model    Serial #
                                                                                     I.D. Tag #  
 

         Printer Brand/Model    Serial #
                                                                                     I.D. Tag # 
 

Is your equipment on a network?    Choose One Yes No If yes, what type of network? 



Describe the problem you are having.


Referred By   Select One Google Search MSN Search Yahoo Search Lycos Search AtlaVista Search ICSGeorgia.Com RealNova.Com Lalrea.Com IBM Lenovo HP Lexmark Radio Newspaper Friend Other