CIPO - Technical Problem Report


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Technical Problem Report

The following information about your computer system is automatically captured to assist us in identifying your technical problem. Please review these details to ensure accuracy and modify as necessary.
Operating System : compatible Browser : Netscape IP Address : 142.78.41.56

Select the area where the problem occurred:


Have you encountered this type of problem in the past?
Yes No

Please complete the following fields. (if applicable)

The date and time the problem occurred:


The URL you were trying to access:


The application or page you were using or attempting to use:


The error message you received:


Your Strategis User name:


Additional comments (description of problem encountered):

How would you like to be contacted?

* Required information

Greeting
First Name*
Last Name*
Title
Organization
E-mail Address
Telephone	() –
(Extension or International phone numbers)
Fax	() –
(International fax numbers)
Street Address
City
Province (Canadian residents only)
State (other) (non-residents)
Postal/Zip code
Country

Protected when completed.


	Last Modified: 2004-09-28		Important Notices