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Technical Support Request Form

Contact Information Your name: Your Phone #: Your E-mail address: Yes, I have a support contract Contract ID:

System Information Product: LanPass 115 LanPass 125 LanPass 250 FastSwitch 200 FastSwitch 400 LG 10Mpbs LG 10Mpbs/w LG 100Mpbs LG 100Mpbs/w Your operating system: Windows 98 Windows 2000 Windows XP Windows NT Macintosh UNIX Linux OS/2 System memory: 0-64MB 65-256MB 257+MB

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LanGear Inc. • 414 Wittlow Way • Farley, SD 85312 • 1 (800) 555-2377