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Product Assistance Request Form
Name:
Company:
Address:
Phone: Fax:
E-mail:
Hardware Specific Information
Computer: CPU:
System memory: PCI Chipset:
System BIOS rev:
Video card used: Resolution:
Network Card: Network Software:
Other cards in system:
Software Specific Information
Operating system: Rev:
Matrox SW used: Rev:
Compiler: Rev:
Fill out only if you are returning a board
RMA #:
Who were you talking to in customer support?
Date board was received: Date of failure:
MOD #: These numbers are on the label at the back of the board.
SER #:
REV #:
PMB #:
PNS #:
Can you reproduce the problem? Yes
❐ No ❐
Is an error code displayed? Yes ❐ No ❐
If so, what code?
... Continued on reverse
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