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Technical Support Request Form

 

Agency Name*
Contact Information:

First Name*

Last Name*

E-mail*

Phone* 

Fax* 

Software:*

Version:

PIN #:*

 (Program Identification Number)
This form requires a PIN.  For non Contractual Request  use a valid Credit Card Number.

CRN #:*

 (Course Registration Number)
*HSU offers FREE technical support to students who attend trainings or on-site services for 3 months. Tech support after that requires a PIN number or users must pay fee listed below.  CRN numbers will be verified before contact is made.  Outdated CRN numbers will be identified as an invalid request.

:

Issue or Problem:
For Non-Contractual Agencies Only!

Fee Charged:  $75.00

Billing Information

* Method of Payment:

Card No.  Expiration Date

Authorizing Manager:
*Credit Card will be processed before contact is made.
Failure to complete required fields will result invalid request form.  Invalid request forms will be deleted or ignored. Credit cards that are rejected, will be determined as invalid and request will be deleted.

*required fields
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