|
*
Customer number
|
|
|
* First Name |
|
|
* Last Name |
|
|
* Email |
|
|
* Phone |
|
|
* Address 1 |
|
|
Address 2 |
|
|
*
City |
|
|
*
State
|
|
|
*
Zip
|
|
|
*
Country
|
|
|
Camera Model
|
|
|
Serial number of body |
|
|
Serial number of digital back
|
|
|
Lens Model
|
|
|
*
Serial number of lens
|
|
|
*
Scanner Model
|
|
|
*
Serail number of scanner
|
|
|
Firmware in body
|
|
|
Firmware in digital back
|
|
|
Phocus Version
|
|
|
Flexcolor Version
|
|
|
*
Platform
|
|
|
*
Operating System Version
|
|
|
*
Select one
|
|
|
Card type
|
|
|
Make and model card used
|
|
|
*
Description of problem
|
|
| |
|
