Accurate Data Recovery 18 Hurndale Ave Toronto, Ont Canada, M4K 1R7 1-888 241 DATA (3282) local 416-465 4103 Fax 416-465 7223

Company Name:_________________________ Email Address:____________________
Contact Person: _________________________ Position: _________________________
Phone:________________________ Fax: ______________________________
Shipping Address:__________________________________________________
________________________________________________________________
City: ____________________________ State/Prov: _____________________
Country:______________________ Zip/Postal Code: _____________________

Please try to fill in as much detail as possible.

Type of Computer: _____________________________________
Make/Model: __________________________________________

Operating System Version (example: Windows 95):_______________________________
Unix / Novel admin name: ____________________ Password: ______________________
Number of Partitions or Volumes: ________ Volume Names: ________________________

Tape Drive, Model:__________________________ Capacity Mb: _____________
Backup Software:________________________ Password: ________________

Hard Disk, Make/Model:_____________________ Capacity Mb: ____________________
Serial Number:______________________  Is Drive under warranty: Yes [ ], No [ ]

Disk Interface: MFM [ ], RLL [ ], IDE [ ], Enhanced IDE [ ], SCSI [ ]
Other:________________________________________________________

Compression: None [ ], Double space [ ], Stacker [ ]
Other:________________________________________________________
Compression software version (example: V7.0):_________________________

Detail events leading up to your disk/tape failure ( noises heard etc.):
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Does the computer see the drive: Yes [ ], No [ ]

List files and directories most needed:
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

Where did you hear about our company?
Search Engines:
Yahoo     [ ]                  HotBot   [ ]                    InfoSeek    [ ]                   WebCrawler   [ ]
LinkStar  [ ]                  Excite     [ ]                    Lycos         [ ]                   Alta Vista       [ ]

Others Sources: (newspaper, magazines, word of mouth, etc.)  _______________________

Tell us what KEYWORD you searched under to find us _____________________________

Shipping Information

It is very important to fill out the air waybill form (shipping document) correctly in order to avoid any delays in processing your disk through customs.

Please indicate that the contents are a "Computer disk for data recovery repair only. Non-functioning". The harmonized code is 8471.70.10.13

The value for Customs should only be $50.00 in order to minimize any delays for taxes or duties payable.

If you are sending the parcel by AIRBORNE EXPRESS please ensure that custom brokerage charges are paid by the sender Accurate Data Recovery will not pay for Customs clearance on inbound shipments.

Terms of Agreement

I, the undersigned have legitimate rights to this data storage device and the data stored on it. I authorize Accurate Data Recovery determine if data recovery is possible and provide an estimate of the recovery costs.

Approved, authorized by: Name (please print):_________________________________

Signature of authorized:_________________________________ Date:____________

Once completed please put this form in the box with the disk and fax the shippers tracking number to Accurate Data Recovery.
(c) Accurate Data Recovery 1998. Copy Rights Reserved.