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To request support for the Ergotest™ assessment platform, fill out and submit the form below, or email us at support@ergocentricsoftware.com. Please allow one to two business days for processing. If you have an emergency support issue, please contact your Ergocentric Software representative directly for immediate assistance.

Please Note: If you use the Student version of Ergotest™, please contact your university or company's technical support department for assistance. Thank you.

Your Contact and System Information:

Your Name:
Email Address:
Confirm Email Address:
Phone Number:
Preferred Contact:	Phone Email No Preference
Operating System:	(Please Select One) Windows XP Windows ME Windows 2000 Windows 98 Windows 95 Windows NT 4 Windows 3.x DOS Other
If Other, Please Specify:
Web Browser:	(Please Select One) Microsoft Internet Explorer 6.x Microsoft Internet Explorer 5.x Netscape Navigator 7.x Netscape Navigator 6.x Firefox AOL Other
If Other, Please Specify:

Description of Issue:
Please include as much information as possible, including whether the problem can be reproduced and the steps needed to reproduce it. If not, in what circumstances did the problem occur? If the problem caused an error message, what did it say?

Your Ergotest™ Role:	(Please Select One) Ergotest Designer Ergotest Administrator
Ergotest™ Software Version: