Name:

E-Mail:

Contact Telephone Number:

Your Mother's maiden name or Helpdesk phrase (for security):

Your Computer

Computer type:
Computer Type... --------- IBM compatible PC Other/Don't know

Operating system:
Operating System... --------- Microsoft Windows ME Microsoft Windows 2000 Microsoft Windows 98 Microsoft Windows 95 Microsoft Windows 3.1 Microsoft Windows for Workgroups 3.11 Microsoft Windows NT UNIX Other/Don't know

Your Modem

What make and model of modem do you have?

What speed is your modem?
Modem Speed... --------- ISDN 56k 33.6k 28.8k 14.4k Other/Don't know

To which Comm port is your modem connected?
Comm Port... --------- 1 2 3 4 Don't know

Your Internet software

What is the registration number of your BTinternet software?
This number (of the format ABC01234567) is printed on the CD sleeve or Disk 1 of a floppy disk set.

Do you have fax software installed on your computer?
Yes No

What other Internet software is installed on your computer?

Please describe the FULL nature of the problem(s) you are experiencing. Be as specific as possible.