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* Name:
* E-mail Address:
* Phone Number:
* City/Town:
* Province:
* Date Experienced:
* Time Experienced:
* Internet Service Provider:

Please indicated what browser you where using when you experienced the problem:
IE 10.x	Safari		Other -please specify
IE 9.x	Google Chrome
IE 8.x	Mozilla Firefox
IE 7.x	Opera

Select your operating system:
Windows XP	Windows Vista	Windows 7
MacOS9	MacOSX	UNIX
Mobile	Other

What are you using to connect to the Internet?
14.4k modem		28.8k modem	33.3k modem
56k modem		High Speed/DSL	Don't Know/Other

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