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CCS Support / Service Call Request

Your Contact Information

TYPE?	Customer Retailer

Name		Company
Phone		Fax
Email		URL

STATUS?	Urgent System Down

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Problem Description
   TYPE? Hardware   Software              Other

            Server    Desktop      POS Other
              UNIX      Linux Windows Other
     CounterPoint Passport    Focus Other

          Problem

      CALLBACK ON:    Date       Time
                      Back Line Number

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