Customer Information:

* Name:

Phone Number:

* E-mail Address:

School/Organization:

District:

Customer Code (Lexia Reading Users Only):

Product Information:

Please select a product Lexia Reading: Early Reading Lexia Reading: Primary Reading Lexia Reading: Foundation Reading Lexia Reading: Strategies for Older Students Quick Reading Test Early Reading (CD or Network) Primary Reading (CD or Network) Foundation Reading (CD or Network) Strategies for Older Students (CD or Network) Lexia Admin (CD or Network) Lexia Server Database Service Lexia Data Monitor Cross-Trainer Inicio a la Lectura Comprehensive Reading Test Teaching Reading: Stages & Strategies Other

Version Number:

Please specifiy activity or unit number, if applicable:

To find your pre-Lexia Reading product version, look on the back bottom of your CD case for the code (e.g. XXCD-X.X) or Start your Lexia program and look for product version on the Select a Student Name Screen. It is on the bottom left.

To find your product version for Lexia Reading, please refer to this FAQ.

Workstation Operating Systems:

(check all that apply):

Windows    Please select a version number Windows 7 Windows Vista Windows XP Windows 2000 Windows 98

Mac OS X    Please select a version number OS X 10.6 (Snow Leopard) OS X 10.5 (Leopard) OS X 10.4 (Tiger) OS X 10.3 (Panther) OS X 10.2 (Jaguar)

Mac OS 9.2

Workstation Browser:

Browser Version   Please select a version number Firefox 2 Firefox 3 Internet Explorer 8 Internet Explorer 7 Internet Explorer 6 Internet Explorer 5 Internet Explorer 4 Google Chrome Safari 4 Safari 3 Safari 2

Server Operating System (For Pre-Lexia Reading Products Running on a Network Server):

Please select an OS and version Windows 2008 Server Windows 2003 Server Windows 2000 Server Mac OS X 10.6 Server Mac OS X 10.5 Server Mac OS X 10.4 Server

Full Description of Problem (provide as much detail as possible):