Appendix D:  System Issue Report 
Form
Note: An on-line / automatic submission version of this form is available at http://
support.intel.com/support/motherboards/server/S5000XVN/. For the fastest service, 
please submit your form via the Internet.
Date Submitted: _______________________________________________________
Company Name:  ______________________________________________________
Contact Name: ________________________________________________________
Email Address:  _______________________________________________________
Intel Workstation Product:  ______________________________________________
Priority (Critical, Hot, High, Low):  _______________________________________
Brief Problem Description. Provide a brief description below. See the last page for space 
to include a detailed problem description.
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Board / Chassis Information
Baseboard Revision - PBA#: _____________________________________________
Baseboard Serial Number: _______________________________________________
Chassis Model:________________________________________________________
CPU1 Speed/Stepping/Spec: _____________________________________________
CPU2 Speed/Stepping/Spec: _____________________________________________
System BIOS Version: __________________________________________________
HSC Firmware Version: _________________________________________________
BMC Firmware Version: ________________________________________________