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You'll need to fill out the form below in order to begin reporting your "problem". All input fields are required, so do not leave any of them blank. Incorrect or incomplete information will result in the form being ignored. Offensive information will result in the form being ignored.

It's not too late to click here and forget the whole thing.

TELEFISH ONLINE PROBLEM REPORTING TOOL
URL where problem occurred:
Browser make and model:
Computer make and model:
Enter a brief description of the problem:
On a scale of 1 - 10, rate the severity of the problem:
Enter the cost to you in US Dollars attributed to this problem:
Enter the following information about yourself:
Your email address:
Name:
Address:
Zip or Postal code:
Home telephone number:
Work telephone number:
Pager number:
Spouse's pager number:
Age:
Weight:
Height:
Eyecolor:
Political affiliation:
Religious affiliation:
Tax ID number:
Employer:
Employer's home telephone number:
Number of televisions in your household:
Average annual income of your household:
Favorite toothpaste:
Least favorite toothpaste:
Do you have a history of mental illness?     yes unsure
Next of kin:
Next of kin pager number:
Select the largest number of people for whom you make each of the following decisions:
Software purchases:     one    two    3 to 10    20 or more
Laxative purchases:     one    two    3 to 10    20 or more
Butter substitute purchases:     one    two    3 to 10    20 or more
Bedtime:     one    two    3 to 10    20 or more
Radio station:     one    two    3 to 10    20 or more
Hair style:     one    two    3 to 10    20 or more
Vacation destination:     one    two    3 to 10    20 or more
Please enter your favorite color at the time the problem occurred:
I fully appreciate the value of the Webmaster's time     yes no
I have reviewed the information above and do hereby certify the correctness and completeness of all data on this form: yes no