<CENTER>
<FORM METHOD="GET" ACTION="&SCRIPT_NAME">
   <INPUT TYPE="HIDDEN" NAME="ACTION" VALUE="Ack">

   <TABLE SUMMARY="Acknowledge input" BORDER=0>
     <TR>
          <TD><FONT FACE="Arial, Helvetica" COLOR="silver"><B>Estimated time to resolve issue: </B></FONT></TD>
          <TD><FONT FACE="Arial, Helvetica" COLOR="silver"><INPUT TYPE=TEXT NAME="DELAY" VALUE="60" SIZE=4 MAXLENGTH=4> minutes</FONT></TD>
     </TR>

     <TR>
        <TD><FONT FACE="Arial, Helvetica" COLOR="silver"><B>Explanation/Cause of problem: </B></FONT></TD>
        <TD><FONT FACE="Arial, Helvetica" COLOR="silver"><INPUT TYPE=TEXT NAME="MESSAGE" SIZE=60 MAXLENGTH=80></FONT></TD>
     </TR>

     <TR>
        <TD><FONT FACE="Arial, Helvetica" COLOR="silver"><B>Acknowledgment Code: </B></FONT></TD>
        <TD><FONT FACE="Arial, Helvetica" COLOR="silver"><INPUT TYPE=TEXT NAME="NUMBER" SIZE=7 MAXLENGTH=7></FONT></TD>
     </TR>

     <TR>
        <TD COLSPAN=2 ALIGN=CENTER>
          <BR><BR>
          <INPUT TYPE="SUBMIT" NAME="Send" VALUE="Send" ALT="Send">
        </TD>
     </TR>
   </TABLE>
</FORM>
</CENTER>