In order for us to understand your problem, we advise you to answer all the
questions. Circle the most appropriate for multiple/single choice questions.
We can assure you that; based on your answers; we will send an engineer within
two months upon receiving the completed form.

1. Describe your problem:
________________________________________________________________
________________________________________________________________

2. Now, describe the problem accurately:
________________________________________________________________
________________________________________________________________

3. Speculate wildly about the cause of the problem:
________________________________________________________________
________________________________________________________________

4. Problem Severity:

A. Minor__
B. Minor__
C. Minor__
D. Trivial__

5. Nature of the problem:

A. Locked Up__
B. Frozen__
C. Hung__
D. Strange Smell__

6. Is your computer plugged in? Yes__ No__

7. Is it turned on? Yes__ No__

8. Have you tried to fix it yourself? Yes__ No__

9. Have you made it worse? Yes__

10. Have you had "a friend" who "Knows all about computers" try
to fix it for you? Yes__ No__

11. Did they make it even worse? Yes__

12. Have you read the manual? Yes__ No__

13. Are you sure you've read the manual? Maybe__ No__

14. Are you absolutely certain you've read the manual? No__

15. If you read the manual, do you think you understood it? Yes__ No__

16. If 'Yes' then explain why you can't fix the problem yourself.
__________________________________________________________
__________________________________________________________

17. What were you doing with your computer at the time the problem
occurred?
__________________________________________________________
__________________________________________________________

l8. If you answered 'nothing' then explain why you were logged in?
__________________________________________________________
__________________________________________________________

l9. Are you sure you aren't imagining the problem? Yes__ No__

20. Does the clock on your home VCR blink 12:00? Yes__ What's a VCR?__

21. Do you have a copy of 'PCs for Dummies'? Yes__ No__

22. Do you have any independent witnesses to the problem? Yes__ No__

23. Do you have any electronics products that DO work? Yes__ No__

24. Is there anyone else you could blame this problem on? Yes__ No__

25. Have you given the machine a good whack on the top? Yes__ No__

26. Is the machine on fire? Yes__ Not Yet__

27. Can you do something else instead of bothering me? Yes__