Matrox Electronic Systems II User Manual

Page 133

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Product Assistance Request Form

Name:
Company:
Address:
Phone:

Fax:

E-mail:

Hardware Specific Information
Computer:

CPU:

System memory:

PCI Chipset:

System BIOS rev:
Video card used:

Resolution:

Network Card:

Network Software:

Other cards in system:

Software Specific Information
Operating system:

Rev:

Matrox SW used:

Rev:

Compiler:

Rev:

Fill out only if you are returning a board
RMA #:
Who were you talking to in customer support?
Date board was received:

Date of failure:

MOD #:

These numbers are on the label at the
back of the board.

SER #:
REV #:
PMB #:
PNS #:

Can you reproduce the problem? Yes

No

Is an error code displayed? Yes

No

If so, what code?

... Continued on reverse

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