Evaluation Form

Accurate Data Recovery
18 Hurndale Ave
Toronto, Ont
Canada, M4K 1R7
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 XP):_______________________________
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 Gb: ____________________
Serial Number:______________________  Is Drive under warranty: Yes [ ], No [ ]

Disk Interface: SATA [ ], Fibre [ ], IDE [ ], Enhanced IDE [ ], SCSI [ ]

Compression: None [ ], Double space [ ], Stacker [ ]
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     [ ]                  Yahoo paid add   [ ]                 Google    [ ]              Google paid add   [ ]
ASK  [ ]                  AOL     [ ]                    Comcast         [ ]                   MSN       [ ]

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 $10.00 in order to minimize any delays for taxes or duties payable.

If you are sending the parcel by Ground Service 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.