Reliable Data Recovery Services Request Form

Tel: (800) 444-3225  Direct Dial Number (770) 925-4420
Fax Number (770) 925-8808

Instructions:

Print this form, fill it out and sign, then fax us a copy and include the original with the media/equipment you ship. 

Upon receiving your package we will contact you and confirm recovery, lead time, etc... 

For questions on any of the below, please call us at one of the above numbers.  Our customer service representatives are ready and waiting for your call.

Contact Information

Company / Organization:

Contact:

Address:

Tel:

Fax:

Email:

Cell/Pager:

Referring Dealer (if applicable): Reliable Data Recovery Services ID #1083

Media for Recovery

Media Type: ___HD,  ___CD, ___Jazz, ___Zip, ___Tape

 __________________________________Other (specify):

Can we break the seals on the media?

___ YES (This may void warranty)    ___ NO

Operating System and Version:

Manufacturer:

Model:

How many partitions or volumes on the media?

Serial #:

How much data is on the media?

What are the most important files, folders, and directories to be recovered?
(exam. /My Documents)

What media should be used to return your data?

___CD ROM

___The formatted drive I have included

___I wish to buy a hard drive

___Other (specify):

 ____________________________

Circumstances

Circumstances of Failure or In- Accessibility:

What solutions have already been tried?

Send and Return Shipping

Courier/Shipping Company Used:

Way Bill # so we can track it:

Terms and Conditions

Approved By (Print):__________________________________________ 

Date:___________________________

Signature: X___________________________________________________