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First Name *
Last Name *
Email Address *
Preferred method of contact? (email or phone) *
Detailed problem/s description *
Phone No. (inc STD code)
Mobile Phone Number
Other Email Address
Hardware problem?	Yes No
Software Problem?	Yes No
Windows XP?	Yes No
If No, enter Op System
Is it a laptop?	Yes No
Connected to the Internet?	Yes No
Can you start up and connect to the Internet?	Yes No
Can you start the machine at all?	Yes No
Do you have original Windows CD's for this machine?	Yes No
Have you backed up important data (eg. CD or floppy)?	Yes No
Do you use a firewall?	Yes No
Do you use Anti-virus sofware?	Yes No
Do you use Internet Explorer?	Yes No
What date (if any) do you need a fix by?
Are you a home PC user?	Yes No
Are you a small business user?	Yes No


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