L A Bridge: Trouble Ticket

TROUBLE TICKET
Report Form

First Name:

Last Name:

Company (if any):

Nature of problem:

Current Email:
Where we can email now

User Login Name:
(i.e. jsmith)

Can-be-reached Phone#:
(example: 3105551212)

Phone Number that DSL is on or...
or dial-in # (ends in 1315)

Connection Speed:

Operating System:

What type of modem (if any)?
dial-up:
None 56K or less
DSL:
Westell Fujitsu other

if "other", brand of modem?:

Software Giving You the Error:
(i.e. Explorer, Firefox, Outlook)

Software Version Number:
()

Exact Error Message (or ping/traceroute test results):

Description of Problem: ()

L A Bridge Internet & DSL
P.O. Box 1001, Pollock Pines, CA 95726
v: 310.228.3626 ~