Does anyone work on a helpdesk where they have a standardized e-mail the users need to use when requesting help? I have been give the task of creating one of these and I was wondering if anyone had one they could post or send me to compare mine to. Anything would be helpful.

So far I have the following:

For Support Requests Via E-Mail:
Name:
Phone # :
Facility Name Where You Are Now:
Application (the computer program you are working with):
Problem With The Application:


Anyone want to make any suggestions?