Virus Report Form

This project is designed to provide an interactive reporting system that enhances Joe Wells' Wildlist. E-Mail addresses, Names and Possition are gathered strictly for authentification reasons, and *WILL NOT* be released to, viewed by, or in any manner made availale to third parties.
Reports from faked E-Mail addresses will not be included in the tally. All virus names will be translated into their CARO Name for the final output.
Reports will be processed once per 24 hours, multiple reports from a single E-Mail address will be confirmed with a single message.

Virus Name:     Anti-Virus Product:
Did you confirm this with a second product?    Yes No
Second Product's Name:

Number of infected machines:

(Numbers only, no commas or decimals)

Number of Disks/ Diskettes infected:

(Numbers only, no commas, or decimals)

Location Information
City:     State/ Province:
Country:
    Home    Office     Both / Same

Comments:

For Authentication Only - we do not store this information

Name: Title:
E-Mail Address: Company (Optional):

Thank you for your help.

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