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MEMCO SYSTEMS       EVALUATION REQUEST FORM
INSTRUCTIONS - Print Form. Complete. Sign. Fax us a copy. Include the original with the media/equipment you ship.
Company / Organization:
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Address:
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Contact:
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Email:
Telephone:
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Fax:
Media For Recovery (Manufacturer, Model and Serial number):
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Interface:
___SCSI, ___IDE, ___EIDE, ___Removable, ___Optical, ___Tape (for Tape specify software and version):
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For: ___ESDI, ___RAID, ___ST-MFM, ___ST-RLL send the controller card (if available) and setup software (if applicable).
If not available, state brand and model number:
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Is the media currently under warranty?: ___ Yes, ___ No (If you check No, we may open the drive for inspection.)
(Note: We will not open or break the seals on the media in the initial evaluation unless approval is given below.)
Can we break the seals on the media if necessary for evaluation?: ___ Yes (May void warranty), ___ No
(Note: Seagate/Conner, Western Digital, NEC, Maxtor, Quantum, Fujitsu Canada and Fujitsu America will honor the warranty for drives returned with our  tamper-resistant seals.)
Computer Type:
___PC, ___MAC, ___PS-2, ___Workstation, ___Other:
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How recent is your last valid backup?
Operating System:
___DOS, ___WIN 3.x, ___WIN 95/98, ___WIN NT, ___MAC, ___Netware, ___UNIX, ___OS2, ___Other:
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Operating System Version Number:
Was any special partition or compression software used? ___ Yes, ___ No
If Yes, Specify: ___Disk Manager, ___DoubleSpace, ___Stacker
___Other:
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How many partitions or volumes on the media?
Circumstances of Failure or Inaccess:
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What remedies have already been tried?
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What are the most important files, folders, and directories, to be recovered?
If you need ALL data, please tell us what is on the media. Use extra paper if necessary. Include an old directory if available.
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Returned Data: If the original media is not functional, what media should be used to return your data?
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___CD ROM, ___The formatted drive I have included, ___3 1/2" Floppy (HD), ___ZIP Disk, ___JAZ Disk, ___Syquest

___4mm DAT Tape (Include sample B/U tape for alignment), ___8mm Exabyte Tape, ___DLT Tape,
For recoveries to TAPE, specify software and version required:
Terms of Agreement

I am the legal owner, representative, or otherwise have legitimate rights to this property and all data contained therein. I authorize
Memco Systems to receive and transport this media as necessary.

This media is being sent to Memco Systems
to determine if recovery is possible and to provide an estimate of recovery costs. The initial evaluation fee is $75 and NO work beyond this evaluation will be charged without explicit client approval.

Memco Systems
shall not be liable for any claims regarding the physical functioning of system components (including hard drives) during or after service. We are not responsible for any items left more than 30 days.

I agree to provide FULL Payment of approved charges before return of data and/or equipment.  Should I decline recovery or if recovery is not possible, I understand there is no charge except the evaluation and shipping charge.

You only pay for our recovery services, if (and only if) we successfully recover the "actual data" you need."  I agree to pay for return shipping for all media/equipment sent regardless of whether I decide to recover or not.

I will not hold Memco Systems responsible or liable for any data loss.  Under no circumstances will Memco Systems be liable in any way for any damages including but not limited to lost revenue, lost wages, lost data, lost equipment, or any other incidental or consequential damages arising out of the service work performed by Memco Systems.


Approved By (Print):__________________________________________ Date:___________________________
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Signature:___________________________________________________


Please print this form and fax it to Memco Systems at (808) 522-0010