Support Request Form

We Look Forward to Serving You!

1) Contact Information
Name (Required)
Position (Required)
Company (Required)
         City State
Email (Required)
Phone (Required)  
My company has not used Millennium Systems® before today.
2) Please tell us about your issue & when we you want resolution
Non-Critical - Next Visit Non-Critical - When Convenient
Important - Within 1 Week Important - 48-72 Hours
Critical - Within 48 Hours Critical - 4 to 6 Hours!*
 *If this is a Critical, System Down Emergency, please call us as well.  Leave a message at extension 200 if no-one is available.  Premium charges may apply to any emergency response calls.
3) Please describe you issue in detail, error messages, timeline
This a recurring issue? Yes No
4) Please tell us how we're doing (optional)

Are you pleased with our service ?
Yes No

If No, would you please take the time to explain ?

Would you recommend Millennium Systems® to a friend ?
Yes No

If Yes, and you know someone who could benefit from our services, please provide us with contact information
How could we improve our service to you?

Would you like information on our other service offerings ?
Yes No

Thank you!  We'll be contacting you shortly

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