Room: Date:

Help Needed! I am experiencing technology problems with the following: (please check)

PC won't turn on is slow freezes frequently other
STORAGE CD-ROM A drive Hard Drive other
PRINTER won't turn on needs ink (list the model# or the cartridge # below) smearing/light output other
INTERNET can't get on is slow blocked from sites other
E-MAIL can't access can't send/receive unsure how to use other
SOFTWARE needs installation doesn't work unsure how to use other
MISC needs installation doesn't work unsure how to use other

For any OTHER checked above, please describe the problem and/or equipment so that I can
efficiently address your needs. Also, please indicate what measures YOU took to fix the problem.

Form last updated on September 13, 2006