Data Recovery Service Form

Data Recovery Service Form
The information entered here is NOT transmitted online. This data recovery service form is intended to be printed.
Please complete, print, sign and include this form in the box with your hard drive. Ship to the address below.

Advanced Computing Solutions, Inc. Data Recovery Logo
5036 Dr Phillips Blvd, #187
Orlando, FL 32819

Phone #: 407-583-6123 Fax #: 407-370-9480

1. Contact Information
Contact Person:
Company Name:
Phone #: ext.   Alternate Phone #:
Address:
City:   State:   Zip:
E-Mail Address:

2. Evaluation Service Type

For preferred service, please enter your reservation number here:

3. Payment Information
Payment Type:
Name on Card:
Credit Card #:   Exp. Date:   CCV*:
*Credit Card Verification (For Visa, M/C, & Discover, the last 3 digits on back of card on the signature line. For AMEX, the 4 digits on the front of the card above the card number.)

Check if the billing address is the same as entered above. If not, please enter below.
Billing Address:
City:   State:   Zip:

4. Data Information
Manufacturer of drive:   Model #:
Number of partitions/drive letters:   How much data on the drive?:
Is there an operation system on the drive?:
How is the drive formatted?:
Did the drive stop spinning?:   Any abnormal sounds (ex: clicking, etc.):

Important: Please list the most import files, folders, and/or file extensions, in order of importance from first to last below. (ex: My Documents, etc.)

Please briefly describe what happened when the failure occurred:

Have there been any recovery attempts made on this drive?:   If yes, please describe below:

5. Destination Media Preference
Type of media you would like your recovered data transferred to:

6. How did you hear about us?

7. Terms and Conditions
Customer engages Advanced Computing Solutions, Inc ("ACS, Inc") and/or its partners or subcontractors to: inspect, evaluate, and identify the problem (if not already identified); and/or retrieve, or minimize the damage to, the equipment/data/media; and/or provide other services as may be requested by customer from time to time. Customer agrees to pay ACS, Inc all fees and sums authorized by customer, which may include charges for the data recovery work performed, priority fees, service fees, evaluation fees, shipping & handling fees, and all services used in the Engagement. Customer agrees that verbal authorization to proceed with the job is a legal binding contract, and that all monies will be due upon completion of job. Failure to pay may result in additional charges such as attorney and court fees in the event that ACS, Inc has to pursue legal action to collect monies due by customer. Customer agrees that a NSF fee will apply for checks that are returned insufficient. Customer agrees that all service fees are non-refundable. Customer agrees that they are to list important data requested in section 4 of this form, and that ACS Inc will not be held liable for data that was not listed. Customer acknowledges that the equipment/data/media may be damaged prior to ACS, Inc receipt, and customer further acknowledges that the efforts by ACS, Inc to complete the engagement may result in further damage or destruction to the equipment/data/media. ACS, Inc will not assume responsibility for additional damage that may occur to the customer's equipment/data/media during ACS, Inc efforts to complete the engagement. Customer warrants to ACS, Inc that they are the owner of, and/or have the right to be in possession of all equipment/data/media furnished to ACS, Inc. Customer agrees that any equipment sent in for evaluation will be considered the property of ACS, Inc if not claimed within 60 days of the last contact attempt. Customer agrees that ACS, Inc will not warrant any equipment/data/media that has been received by customer from ACS, Inc. Customer agrees that in no event will ACS, Inc be liable for any direct or indirect damages whatsoever. Including data loss due to virus, worm, trojan horse, etc. The total liability of ACS, Inc to customer under this agreement shall in no event exceed the total sums pay by customer to ACS, Inc. Customer will defend, at their expense, indemnify, and hold ACS, Inc harmless against any damages or expenses that may occur (including reasonable attorney's fees), and pay any cost, damages, or attorney's fees awarded against ACS, Inc resulting from customer's breach of this section.

I agree to the above terms and conditions and authorize Advanced Computing Solutions, Inc to charge the card listed on this form, or promise to pay with approved method of payment as indicated, for any priority fees, service fees and/or feeds charged for this engagement.

Approved by (Print Name): _____________________________________________________

Signature: __________________________________________ Date:__________________

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