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Subject *

Description *

Severity

Date/Time Incident Observed

Frequency of Issue

Number of Users/Agents Affected

Troubleshooting Steps Taken:

Service Product

Product Version:

Recording Architecture (for QM only)

If Other (Recording Architecture )

End Customer First Name *

End Customer Last Name *

End Customer Company Name *

End Customer Preferred Contact *

End Customer Email *

End Customer Phone *

Preferred Working Region

Has the System Been Recently Updated?