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Mail Drive and Form To:
On-Site Computer Repair
2303 Randall Rd., #133
Carpentersville, IL 60110
1.
CONTACT INFO
Contact Person:
Company Name:
Phone #:
ext.
Cell Phone #:
Address:
City:
State:
Zip:
E-Mail Address:
2.
EVALUATION SERVICE
TYPE
Please select your requested
evaluation service type from the drop down box below.
For priority service, please call for
reservation # to enter here
3.
PAYMENT INFORMATION
Payment Type:
Name On Card:
Credit Card #:
Exp. Date
Security Code*
*(For Visa, M/C,
the last three 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 billing address is the same as entered above. If not, please enter below.
Billing Address:
City:
State:
Zip:
4.
HOW DID YOU HEAR ABOUT
US?
5.
MEDIA STORAGE PREFERENCE
Type of media you would like
your data copied to?
6.
PHYSICAL RECOVERY
(OPTION)
If we find evidence of physical failure, do
you want to proceed with physical recovery attempt?
7.
DATA INFORMATION
Manufacturer of drive:
Model #:
Number of partitions/drive
letters:
How much data is on the drive:
Is there an operating system
on the drive?
How is the drive formatted?
Please briefly describe
below what
happened when the failure occurred:
Did the drive stop spinning?
Any abnormal sounds? (ex: clicking, etc.)
Any recovery attempts made
on this drive?
If yes, please describe
below:
IMPORTANT:
Please list the most important files, folders, and/or file
extensions in order of importance from first to last below.
(Example: My Documents)
8.
TERMS AND CONDITIONS
Customer engages
On-Site Computer Repair, from here on in referred to as "On-Site", 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
On-Site all sums authorized from time to time by Customer, which will
typically include charges for On-Site's services, reasonable travel
and per diem expenses for on-site work, shipping and insurance (both
ways), and actual expenses, if any, for parts, media, and/or off-the-shelf
software used in the Engagement. Unless otherwise agreed to in advance
by On-Site, all such sums are due and payable in advance, by company
check, bank money order, or credit card. Customer acknowledges that
the equipment/data/media may be damaged prior to On-Site's receipt,
and Customer further acknowledges that the efforts of On-Site to complete
the Engagement may result in the destruction of or further damage to
the equipment/data/media. On-Site will not assume responsibility for
additional damage that may occur to the Customer's equipment/data/media
during On-Sites efforts to complete the Engagement. Customer agrees
that any equipment sent in for evaluation will be considered the property
of On-Site if not claimed within 60 days of the last contact attempt.
NO WARRANTIES; DISCLAIMER OF ALL WARRANTIES. ON-SITE MAKES
NO WARRANTY CLAIMS AND CUSTOMER RECEIVES NO WARRANTIES OR CONDITIONS
FOR ANY GOODS OR SERVICE, EXPRESS, IMPLIED, STATUTORY, OR IN ANY COMMUNICATION
WITH CUSTOMER, AND ON-SITE SPECIFICALLY DISCLAIMS ANY IMPLIED WARRANTY
OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE, AND ARISING
FROM USAGE OF TRADE OR COURSE OF DEALING OR PERFORMANCE. In no event
will On-Site be liable for any indirect damages whatsoever. On-Site
will not be held liable for any damages due to any virus, worm, Trojan
horse, etc. The total liability of On-Site to Customer under this Agreement
shall in no event exceed the total sums paid by Customer to On-Site
Customer warrants to On-Site that it is the owner of, and/or has the
right to be in possession of, all equipment/data/media furnished to
On-Site; and Customer will defend, at its expense, indemnify, and
hold On-Site harmless against any damages or expenses that may occur
(including reasonable attorneys’ fees), and pay any cost, damages, or
attorneys’ fees awarded against On-Site resulting from Customer’s breach
of this section.
I agree to the above terms and conditions and
authorize On-Site Computer Repair 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 fees charged for this data recovery service.
Approved by (Print Name):_____________________________________________________
