CONTACT INFORMATION

Company Name:

Telephone:

Cell Phone:

Fax:

Shipping Address:

Billing Address (if different than shipping):

Contact Name(s):

Email Address:

CREDIT CARD INFORMATION:  (The credit card will not be charged unless the recovery is successful.  We accept Visa,                        MC, Amex, and Discover) This must be filled out. No charges are made unless recovery is successful!

Type of card:  Visa   MC  American Express    (circle one) 

Number:                                                                      Exp (mm/yy):              

Name on Card:

INFORMATION ABOUT MEDIA

Please fill in as completely as possible.

What Type of Media: ____ Hard Drive, ____ CD, ____ Jazz, ____ Zip, ____ Tape, ______________________ Other

Can we break the seals on the media if necessary?
___ Yes (May Void Warranty of Drive)   ____ No
 

Operating System:

Type of file System: ( example :NTFS, FAT32, if                  possible.)

Media manufacturer:

Model number:

Number of Volumes or Partitions On Media:

Size in MB or GB of media:

Serial #:

Approximately what percentage of the media was full?

Purchase Date of Media If Known:

Which data is the most important for recovery? (My Documents, finance.xls, proposal.doc, etc.)

What media should be used to return your data?

___Internal hard drive (IDE 3.5")

___External USB hard drive.

___CD-ROM for data less than 650MB

___DVD-ROM (For 8gb of data or less)

Other (we will call you with pricing): ______________________________

______________________________

______________________________

Reason for Loss of Data

What do you believe to be the cause of your data loss: 

What solutions, if any, have already been tried to recover data on the media (please be specific as this can greatly affect                           or hinder the recovery process):

Terms and Conditions

1. Authorization
 The client authorizes Veteran Computer Services, Inc., its employees, and agents, to perform any and all measures                       necessary to recover data from this media and or equipment.
2. Client Legal Rights
 The client is the legal owner, representative, or otherwise has a legitimate right to the property or act on the owners behalf                          and all data contained therein sent to Veteran Computer Services, Inc..
I further state that the recovered data will not be used for any illegal purpose.   I further attest that by Veteran Computer                   Services, Inc. providing recovery or security services they are not participating in any illegal activity.  
3. Liability
 Veteran Computer Services, Inc. assumes no liability for any claims regarding the physical functioning of media and or                               equipment nor the condition or existence of data on storage media supplied before, during or after service.
 Veteran Computer Services, Inc. is not liable for any direct or indirect damages, including loss of data, loss of revenue,                       incidental or consequential, before, during or after service and also assumes no liability for uninsured shipments.   Any                      property left with Veteran Computer Services, Inc. unclaimed for 30 days, will be disposed.
4. Confidentiality
  Veteran Computer Services, Inc. and its officers and employees know your data is highly confidential and will not disclose                    any data to any third party unless under final appeal and penalty of State or Federal Law. Veteran Computer Services, Inc.               provides an absolute NON DISCLOSURE of any customer data.
5. Payment
 Client agrees to pay in full upon completion of services rendered by Veteran Computer Services, Inc.. Payment is due in full                       upon completion of successful recovery and prior to release of data (whether shipped, picked up or downloaded). Other                     payment arrangements may be made prior to recovery.  If we recover the data you are looking for you must pay the price                    quoted for the recovery.  
6. Media Warranty:
 Veteran Computer Services, Inc. gives warranty on all return media found to be Dead on Arrival (DOA) within 10 days of                 shipment. Any additional warranty claims must be presented to the original manufacturer. Veteran Computer Services, Inc.                   keeps all recovered data 10 days to insure against DOA instances.  After 10 days, we destroy all copies of your data.
7. Shipping:
 All shipping and insurance charges are the responsibility of the customer regardless if the data is recovered or not.


Approved By (Print name):__________________________________________

Title:  ____________________________Date:___________________________

 

Signature: X___________________________________________________

Printer Friendly Version