2. 1. Describe your issue:*
4. 2. What were you doing when you had the issue?*
6. 3. What network were you using:*

   1. Lucas County - wired
   2. Lucas County - wireless
   3. Courthouse - wireless
   4. Home
   5. Other***
7. 4. What device were you using when this happened?*

   1. Desktop
   2. Laptop
   3. Other***
9. *** If other, please explain:
11. 5. Enter the date and time that you encountered this issue:*
    5. Enter the date and time that you encountered this issue:

    5. Enter the date and time that you encountered this issue:
13. Your name:*
15. Your phone number:*
17. Thank you for your help identifying these issues and your patience as we resolve them.
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19. 1. Receive an email copy of this form.
20. Email address

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21. Submit

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