Client Information Form

Please fill out this form and fax it to

(925) 426-6309 or include it with
the drive in your shipment.

First Name _______________________ Last Name ______________________

Address 1 _______________________

Address 2 _______________________

City _________________ State ____ ZIP/Postal Code _______

Country __________

Email ___________________________ Contact Phone ___________________

Please provide as much detail as possible:

Device Type External Drive Interface USB

Manufacturer LaCie Size ____ GB

Description of Problem
LaCie External Hard Drive was dropped, the drive is now clicking.

Any Previous Recovery Attempts? yes no

Important Files/Folders to Rescue

The Data Rescue Center Toll Free: (877) 501-4949

307 Ray Street, Pleasanton, CA 94566 Fax: (925) 426-6309
 Disclaimer
You declare to be the rightful owner of the equipment in question and any data stored on it. You authorize The
Data Rescue Center to perform any necessary action to recover your data, including ones that may void the
warranty of any part of the equipment.
The Data Rescue Center will not be liable for any direct or indirect damage that may occur before, during, or after
services have been performed on the equipment, including, but not limited to, physical damage of the equipment,
loss of data, loss of revenue, or any other form of loss.
Data will be recovered exactly as it is seen on customer!s equipment, i.e. files or data can be damaged or
infected by malware (viruses, worms, trojan horses). Customer is strongly advised to use anti-malware
applications when accessing any data.
No refunds are given unless separately agreed to beforehand in writing.

I agree

Terms and Conditions

Customer is responsible for any and all shipping charges, regardless of the outcome of the recovery process. In
case new equipment provided is Dead On Arrival (DOA), The Data Rescue Center will replace it for 10 days after
shipment date; after this period the manufacturer!s warranty will take effect. The Data Rescue Center will keep
recovered data for 10 days to cover for a potential DOA of said new equipment. The Data Rescue Center will
provide a Non-Disclosure Agreement on request.

Digitally signed by James E. Cooper

James E. Cooper DN: cn=James E. Cooper, o, ou,

email=jedwardcooper@gmail.com, c=US
Date: 2010.04.26 22:08:33 -04'00'
Signature ________________________ Date _________

The Data Rescue Center Toll Free: (877) 501-4949

307 Ray Street, Pleasanton, CA 94566 Fax: (925) 426-6309