Data Recovery Request
 
Print this page from your browser and enclose with your drive. Be sure to include the Drive Information Form.
 
CUSTOMER INFORMATION 

Name: _______________________________________________ email: _____________________ 
Company:_______________________________________________________________________ 
Street Address:___________________________________________________________________ 
City/State/ZIP:____________________________________________________________________ 
Voice Phone: __________________________________ FAX Phone: ________________________ 
 
SERVICE LEVEL (Choose One)  

The service level you choose determines how soon we will evaluate your drive. 
You will not be charged the recovery fee until we have your permission to complete the recoveryr. 

[ ] Emergency $1,500  (Evaluated Same Day as Received - we work on it 24 hours a day!) 
[ ] Priority $300. (Evaluated Same Day as Received)   2 - 5 Business day turn-around! 
[ ] Standard $150. (Evaluated by Next Available Agent) 5 - 7 business day turn-around! 
 please note evaluation fees are exclusive of data recovery. 

PAYMENT INFORMATION (Choose One)  
I agree to pay the above amounts in advance by Bank Check or credit card. If credit card, I authorize the above amount to be charged to the following credit card:
[ ] Certified or Bank Check - made payable to Data Recovery, Inc. 
[ ] Visa                      Name on Credit Card: ________________________________________ 
[ ] Master Card          Billing Address: ______________________________________________ Zip ________ 
[ ] AMEX                  Expiration Date: _______  Credit Card Number: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 
[ ] Discover               
                                  Cardholder's Signature ___________________________________ Date ___/___/___

RETURN SHIPPING INFORMATION 

Return Shipping Method (Choose One)           Return Shipping Payment (Choose One) 
[ ] Courier Delivery (greater Boston area only)        [ ] Fedex [ ] UPS    Account #: _______________ 
[ ] UPS Next Day Air                                       [ ] Visa (see above) 
[ ] Fedex Next Day Air                                    [ ] Master Card  (see above) 
 

Return Shipping Insurance (Choose One for UPS/Fedex) 
Data Recovery, Inc. is not responsible for damages incurred during shipping. To insure your 
computer equipment during shipping check the following: 
[ ] I am purchasing shipping insurance from UPS/Fedex. I fully understand the coverage that method 
   of insurance provides. Value of Hard Drive: $____________________ 
[ ] I am declining shipping insurance.  Data Recovery, Inc. will not be held responsible for damage 
   that occurs in transit. 
 
DECLARATION OF OWNERSHIP AND AUTHORITY 

I, _____________________________________________, am the legal owner of the hardware in question, Serial Number: (not required) _______________, and/or am the duly authorized representative of _________________ (Company name if hardware is owned by corporation, agency, etc.) My signature will attest to the fact that I am an officer of the above named company, or am empowered by its governing body, to act in its behalf for matters relating to the attached Agreement in regard to the property identified above. 
________________________ 
(Signature) 
 
DATA RECOVERY WAIVER OF LIABILITY 

I,____________________________, grant permission to Data Recovery, Inc.  to perform any action they deem necessary to attempt to repair my hard drive. I understand that this procedure is a final attempt towards the recovery of data from the hard drive and could result in loss of part, or all, of the data stored thereon and that Data Recovery, Inc.  makes no warranty or guarantee as to the success of its attempts. Furthermore, I release Data Recovery, Inc.  from any liability for any data loss which may occur during, or as a result of, this procedure. I also release Data Recovery, Inc. from any liability for any theft, damage or destruction to the drive and any other hardware sent to Data Recovery, Inc.  in connection with this Waiver, and agree that the sole liability of Data Recovery, Inc.  for the foregoing shall be the fair market value of such hardware, as reasonably determined by Data Recovery, Inc.. All claims for liability and/or loss including without limitation any indirect, incidental or consequential damages which may occur as a result of any Data Recovery, Inc. action (or inaction) are hereby expressly waived. I also understand that, even if the drive is successfully recovered, there is a possibility that individual files and directories on the drive may still be inaccessible due to the type of damage originally sustained. In addition, I agree to pay the applicable fee for these services by Data Recovery, Inc. , plus shipping and handling expenses as follows. Data Recovery, Inc. uses UPS for return shipping. Data Recovery, Inc. does not pay for return shipping. 

I agree to accept the responsibility for shipping the system or hard drive to Data Recovery, Inc. Data Recovery, Inc.  will not be responsible for damages incurred during the shipping process and any loss or claim against such agents shall be solely by and on the behalf of the undersigned.  I agree to all the forgoing conditions. 

__________________________   ____________________  ______________  _____________ 
           (Signature)                            (Phone Number)                        (Title)                       (Date) 
__________________________   ___________________________________ 
             (Print Name)                       (Alternative Phone / Pager / Fax / email