Laptop

Yes No

Projector

Yes No

Speakerphone

Yes No

Date and Time

--Select a Month and Day-- January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

--Select a Start Time-- 8:00 8:15 8:30 8:45 9:00 9:15 9:30 9:45 10:00 10:15 10:30 10:45 11:00 11:15 11:30 11:45 12:00 12:15 12:30 12:45 1:00 1:15 1:30 1:45 2:00 2:15 2:30 2:45 3:00 3:15 3:30 3:45 4:00 4:15 4:30 4:45 5:00 5:15 5:30 5:45 6:00 6:15 6:30 6:45 --Select a Breakdown Time-- 8:00 8:15 8:30 8:45 9:00 9:15 9:30 9:45 10:00 10:15 10:30 10:45 11:00 11:15 11:30 11:45 12:00 12:15 12:30 12:45 1:00 1:15 1:30 1:45 2:00 2:15 2:30 2:45 3:00 3:15 3:30 3:45 4:00 4:15 4:30 4:45 5:00 5:15 5:30 5:45 6:00 6:15 6:30 6:45

Setup Location

Full Name

E-mail

Printer Type and Model

--Select a Printer-- 1012 1100 1200 1300 2100 2300 4000 5si mx 6MP 4600 (Black) 4600 (Cyan) 4600 (Yellow) 4600 (Magenta) 4600 (Image Transfer Kit) 5000 5200 9000 W5310 5100cn (Black) 5100cn (Cyan) 5100cn (Yellow) 5100cn (Magenta) Lanier Printer/Copier/Fax

Location

Full Name

E-mail

Please describe the problem you are having, being as specific as possible. Include the exact text of any error messages you receive. If applicable, please include:

• Steps you were going through when the problem occurred
• URL of Web page that you were using
• How often you experience this problem
• When this problem started occurring
• Any recent changes made to your computer
• Software in which you are experiencing the issue.

Full Name

E-mail

Phone