Matrox Electronic Systems 10760-101-0200 manual Product Assistance Request Form

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