NameAddressCityZip

Email Repeat Email Phone

PC ManufacturerPC Age Less than 1 month Less than 6 mos Less than 1 year Less than two years Older than two years Processor Type Intel P4 Intel PIII Intel PII AMD K2 AMD Athlon Cyrix Other Unknown

Processor Speed 1 - 2Ghz 900 - 1 Ghz 700-800Mhz 400-600 Mhz 100-300 Mhz Don't know 2 mghz or greater    Type Desktop Laptop Palm System Windows XP Windows ME Windows 98 Linux

Select all that apply

Frequent lock-ups   Dial-up problems  Hard drive failure Sound problems

Video problems       Operating system bugs   Other:

Was this computer purchased in conjunction with a rebate from an internet provider such as America Online, or MSN?    Yes   No

How many days has the PC been in the shop?

Please provide any additional information you'd like to add...