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  Problem Information
Type *
Severity *
Critical: Production system down or initial product install failure
Severe: Problem in a major functional area.
Standard: Problem in a minor product feature.
Low: Minor problem with easy work-around or How To Question.
of problem *
Can this problem be reproduced?

If so, how?
  Customer Information
Name *
Company *
Account # *
Telephone *
Email *
  Product Information
Product *  
Version *
OS *