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  1.                 ------------------------------
  2.                 COMMENT AND BUG REPORTING FORM
  3.                 ------------------------------
  4.  
  5. Your comments about this software and documentation are welcome.
  6. Please take the time to fill out this form with your comments.
  7. This form may also be used for reporting any bugs found with the
  8. software.
  9.  
  10. Name: _____________________________  Title:   __________________
  11.  
  12. Company: _______________________________________________________
  13.  
  14. Address: _______________________________________________________
  15.  
  16. ________________________________________________________________
  17.  
  18. City: __________________________________________________________
  19.  
  20. State/Country: ________________________ Zip: ___________________
  21.  
  22. Phone Work: (_____) _____ - ______  Home: (_____) _____ - ______
  23.  
  24. EasyChart Version Number: _____________  Date: _________________
  25.  
  26. EasyChart Serial Number: _____________
  27.  
  28. ________________________________________________________________
  29.  
  30. ________________________________________________________________
  31.  
  32. ________________________________________________________________
  33.  
  34. ________________________________________________________________
  35.  
  36. ________________________________________________________________
  37.  
  38. ________________________________________________________________
  39. ****************************************************************
  40. Send this form to:     PAVITRON Computer Group
  41.                        EasyChart Comments
  42.                        P.O. Box 8062
  43.                        Silver Spring, MD 20907
  44. ****************************************************************
  45.