Your Name: 

Company Name and Address:

Company Beta Number:

CIS I.D. Number:

Work Phone number:

Windows Beta Version (1, 2, 3, etc.):

DOS version:

PROBLEM DESCRIPTION:

STEPS TO REPRODUCE:

Standard or Enhanced Mode:

Computer Brand/Model:

BIOS (with version and date):

Hard Drive Brand and Model:

Controller Brand and Model:

Monitor and Video Card:

Floppy Drive(s):

Mouse Model:

Serial or Bus:

COM or IRQ:

Mouse Driver Version:


Config.sys:

Autoexec.bat:

System.ini:

Win.ini: