Printable Diagnosis Form for Tape Drives

Before you ship your media/device to us, please complete and print this form and include a copy of it with your shipment

Contact Information
Referred By:	Others:
First Name: *
Last Name: *
Company Name:
Address Line: *
City: *
State: *
Zip Code: *
Country: *
Primary Phone Number: *	- -
Cell Phone Number:	- -
Fax Number:	- -
E-mail:
Media/Device Information
Media Type:
Manufacturer:
Name or MDL number of the drive used:
Operating System:
Capacity:
Number of Partitions:
File System:
Software used for backup:
Drives used for backup:
Compressed?
If compressed then what is the compression ratio?
List Critical files and Directories:
Enter Circumstances of Hard Drive Crash:
Terms of Contract:	I agree to allow Optimum Data Recovery, Inc.(ODRI)to perform data recovery process on my device/media. ODRI is not responsible for any damage during shipment and data recovery process. Manufacturer warranty may be void. ODRI is not resposible for any equipment left after 30 days. ODRI reserves the right to transfer the media to company's other national/international facilities if needed.
Agreed with Terms ?
Do you want expedited services?

Signature :_______________________ Date:_____________

Shipping Address:
Optimum Data Recovery, Inc. Houston: 10303 Northwest Freeway, Suite 315 Houston, TX 77092 Chicago: 5901 North Cicero Avenue, Suite 505 Chicago, IL 60646 New York City: Empire State Building 350 Fifth Avenue, 59th Floor New York, NY 10118