Contact Information
Name:
Title:
Company Name:
Address:
City:		State/Province:
Country:		Zip/Postal:
Phone:		Fax:
Email Address:

Model 204 Environment Information
Current Model 204 Production version number:
CPU Make:		CPU Model:
CPUID Number:	Note: List CPUID numbers within the machine (LPARS and/or Multiprocessor). The CPUID number must be sixteen characters.
Operating System:

Client Environment Information
Interface (TCP/IP, or APPC/SNA):
Windows XP, 2000, NT, 4.0, 98:

Shipping Address (including contact name):

Comments: