Complete this form and send to Traverse PC.
Fax: (541) 201-2237
Mail: P.O. Box 105, Florence, Oregon 97439

Customer ID:_______________ Contact:___________________________________________
Company:____________________________________________________________________
Home Phone:____________________ Work Phone:____________________
Cell Phone:____________________
Fax:____________________ E-Mail:_______________________________________________
Mailing Address:______________________________________________________________
City:_________________________ State:________________________ Zip:_______________
Product:____________________________________ Version:_________
Serial Number:___________________ Operating System:_____________________________

Please give us a complete description of your problem or suggestion:
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Thank you for taking the time to report this to us. We always appreciate customer feedback.

FOR INTERNAL USE
Reviewed by:__________________________________________________
Incident #:____________________________________________________
Date Resolved:_________________________________________________