Page 1 of 1
This form allows you to submit a surveillance product failure. We will not disclose your identity to anyone. If we publish the report, we will pay you $20 via PayPal.
Q.1
Who is the manufacturer and what is the model number of the product you are having a problem with?
*
Q.2
What is the current firmware or software version of the product?
Q.3
Describe the problem you have encountered and any feedback the manufacturer has given you about the problem.
Q.4
When did you first encounter this problem?
MM
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
/
DD
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
YYYY
Q.5
What is your name?
First Name
Last Name
Q.6
What is your email address?
*
(e.g. john@example.com)
Page 1 of 1