Technical Support Request Form

This form is designed for customers to report technical issues they are experiencing. Filling out this form will help our support team better understand your problem and respond in a timely and effective manner.

Customer Information

Full Name: {fullName}

Email Address: {email}

Phone Number: {phone}

Company Name: {companyName}

Issue Details

Date of Issue: {issueDate}

Priority Level: {priorityLevel}

Subject: {subject}

Description of the Issue:

{issueDescription}

System Information

Operating System: {operatingSystem}

Browser (if applicable): {browser}

Application/Module Affected: {applicationModule}

Version Number: {version}

Steps to Reproduce

{#steps}

1. {stepDescription}

{/steps}

Attachments

If applicable, the following files were provided as diagnostic support:

{#attachments}

• {fileName}

{/attachments}

Consent and Confirmation

{#consentGiven}✔ The customer has agreed to data processing for diagnostic and support purposes.{/consentGiven}

{^consentGiven}✘ The customer did not give consent for data processing.{/consentGiven}

For Internal Use Only