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<title>Tell us what you think about our web site</title>
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<b><font size="6" face="Verdana">Town of Needham </font></b>
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<p align="center">
<font size="6" face="Verdana"><b>Computer / Hardware Support Request</b></font></p>
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<p align="justify"><font face="Verdana">This web page has been created to allow the IT Center Staff
to better organize and track employee requests for computer and peripheral
hardware support. If in
the future you are unable to access this form to submit a request for computer
or peripheral hardware support because of an issue with your computer the IT Center Staff is always
available by phone at 781-455-7516.</font></p>
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<p><font face="Verdana"><strong>Enter your computer support request in the space provided below:</strong></font></p>
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<dd><font face="Verdana"><textarea name="Comments" rows="10" cols="95"></textarea></font></dd>
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<p><font face="Verdana"><strong>Tell us how to get in touch with you:</strong></font></p>
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<td><!--mstheme--><font face="Trebuchet MS, Arial, Helvetica"><font face="Verdana">Name </font><!--mstheme--></font></td>
<td><!--mstheme--><font face="Trebuchet MS, Arial, Helvetica"><font face="Verdana">
<input type="text" size="35" maxlength="256" name="Username"></font><!--mstheme--></font></td>
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<td><!--mstheme--><font face="Trebuchet MS, Arial, Helvetica"><font face="Verdana">E-mail </font><!--mstheme--></font></td>
<td><!--mstheme--><font face="Trebuchet MS, Arial, Helvetica"><font face="Verdana">
<input type="text" size="35" maxlength="256" name="UserEmail"></font><!--mstheme--></font></td>
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<td><!--mstheme--><font face="Trebuchet MS, Arial, Helvetica"><font face="Verdana">Phone</font><!--mstheme--></font></td>
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<input type="text" size="35" maxlength="256" name="UserTel"></font><!--mstheme--></font></td>
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<dd><font face="Verdana"> </font></dd>
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<input type="submit" value="Submit Request">
<input type="reset" value="Clear Form"></font></p>
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<h5><!--mstheme--><font color="#330099"><font color="#000000" face="Verdana"><br>
Copyright � 2004 [Town of Needham]. All rights reserved.<br>
Revised: <!--webbot bot="TimeStamp" s-type="EDITED" s-format="%m/%d/%y" startspan -->01/09/07<!--webbot bot="TimeStamp" i-checksum="13246" endspan -->.</font><!--mstheme--></font></h5>
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