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| <html>
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| <form action="/action_page.php">
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| <label for="fname">Reporter:</label>
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| <nowiki><input type="text" id="fname" name="fname"></nowiki><nowiki><br></nowiki><nowiki><br></nowiki>
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| <label for="lname">Issue Type:</label>
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| <nowiki><input type="text" id="lname" name="lname"></nowiki><nowiki><br></nowiki><nowiki><br></nowiki>
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| <label for="lname">Issue Name:</label>
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| <nowiki><input type="text" id="lname" name="lname"></nowiki><nowiki><br></nowiki><nowiki><br></nowiki>
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| <label for="lname">Issue Description:</label>
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| <nowiki><input type="text" id="lname" name="lname"></nowiki><nowiki><br></nowiki><nowiki><br></nowiki>
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| <input type="submit" value="Submit">
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| </form>
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| </html>
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