SCL IT Support Request Form

1

Your NamePlease type the name of the person completing this form.

First Name

Last Name

2

Your E-mailPlease type the email of the person completing this form.

3

Your Phone NumberPlease type the Phone Number of the person completing this form (preferebly Cellular)

Area Code

Phone Number

4

I am completing this form for someone else who is need of tech support.

Yes

No

Unsure

Other

5

Name of User in need of IT SupportPlease type the name of the person completing this form.

First Name

Last Name

6

E-mail of User in need of IT SupportPlease type the email of the person in need of IT Support

example@example.com

7

Phone Number of User in need of IT SupportPlease type the Phone Number of the person in need of IT Support (preferebly Cellular)

Area Code

Phone Number

8

Name of Organization/ CompanyThe name of the organizaton under which you/the user are registered here at SCL DYNAMICS INC. If registered as a Family, write "SURNAME - FAMILY." If registered as an individual user, write "FIRSTNAME SURNAME - INDIVIDUAL"

9

Organization's Primary DomainThsi is usually the information follwing the "@" sign in your email address. If registered as an individual user, write "FIRSTNAME SURNAME - INDIVIDUAL"

10

Urgency Level

Emergency (12 to 36 hours)

Urgent (48 to 72 hours)

Urgency level is unclear at the moment

Not Time-Sensitive

Not Applicable

12

I or the User is having a problem with:

My Computer

Delivery of product

Devices attached to Computer (e.g Printer)

Mobile Device (e.g. Tablet)

Cloud Service (e.g. Corporate Google Apps or Corporate Office 365 account)

Internet/ Router

Other

13

Describe Your ProblemThe more infirmation you provide here, the faster your issue can be resolved.

14

Acknowledgement

I the user understand that "Urgency Level" as listed in this form simply provides guidance in triaging IT Support Tickets, and that I must explore other means of addressing my issue in a manner commensurate with the urgency level indicated; including, but not limited to contacting my/ my organization's SCL Advisor. This form - by no means- promises or guarantees a ticket completion date or time.

15

SignatureDraw your signature here

Clear