Exchange Recovery Submission Form
Phone: 800-275-2823  * Int. Phone: +1-727-642-5521 * Fax: 800-675-3967 * Int. Fax: +1-206-374-6297

U.S.A. Branch:

Exchange Recovery Clinic
39 Broadway, 26th Floor
New York, NY 10006

Europe Branch:

Exchange Recovery Clinic/WTS
Media park, 40b River road,
Barking, Essex, IG11 0DW

Exhibit A

RMA #: Please call to determine your RMA number and the lab location which will be used

Client Name:        

Phone Number:                            Ex:         

Fax Number:

E-mail address:

Company Name:

Credit Card Billing Address:

City, State, Zip:

Equipment being sent:

Contact person:

Disclosure and Acceptance:

I hereby authorize evaluation of the above damaged media.  The charges for this service will be:  $___________

Charges for actual data recovery will be forwarded to customer after the diagnosis is completed the initial price range quoted was: $ _____________

Evaluation fee must accompany drive(s).  Company check, cashiers check or credit card is acceptable for this part of the service.

Print name of cardholder: _______________________________________________


             Exp. Date ______________________________________________________

             Signature: ______________________________________________________            

             Title:  __________________________________________________________

             Date: __________________________________________________________



Exhibit B
Drive/Media Information





Model #:

Computer Model:

Controller Model:

Any additional equipment used:

Operating System (Circle): DOS / Novell / Mac / OS2 / UNIX / Irix / WinNT / Others:_

Compress Drive (Circle):  Yes  No

Version of Exchange:

Edb file size (include .stm file for 2000 and 2003):

General Failure:


Any additional information you feel will help us recover your data including any attempts made by you or other parties to recover lost data:


Call to verify the appropriate ERC lab to receive your drive/media and:

  1. Wrap the drive in an anti-static bag or plastic material

  2. Use bubble wrap or peanuts to securely pack the hard drive.

  3. Pack in a box twice the size of the box

  4. Write your RMA # on the outside of the box.

  5. Write the weight on the box and make sure your return address is also on the box





Exhibit C


RMA #:

  LIMITED WARRANTY: E.R.C. warrants only to use its best efforts to identify the problem and provide an estimate, correct the problem, and retrieve or minimize damage to data.

  LIMITATION OF LIABILITY: In no event will E.R.C. be liable for any further damages, including loss of data, lost profits, incidental or consequential, or indirect from damages arising from this engagement. Customer also acknowledges all risks and costs for parts and software if required.

  LIABILITY FOR CERTAIN CLAIMS: E.R.C. in any event, shall not be liable for any damages and will have no liability for any claim from customer or third party, directly or indirectly that equipment and/or data was damaged or rendered unusable.

  UNCONTROLLABLE CIRCUMSTANCES: Either party's performance of any part of this agreement shall be excused if the performance of recovery or estimate is hindered, delayed, or made impossible due to: (a) Acts or omissions or other party, (b) Flood, hurricane, fire, earthquake, strike, war, or riot, (c) Unavailability of parts or software.

  OWNERSHIP OR RIGHT TO HAVE EQUIPMENT INDEMNIFICATION: Customer warrants and represents to E.R.C. that its owner right to be in possession of all equipment and data furnished to E.R.C. and will defend at its expense, such claims against E.R.C.  Any drives or data left unclaimed or unpaid after 30 days will become the property of E.R.C.

Customer Confidentiality

Exchange Recovery Clinic and its officers and employees agree to absolute Non - Disclosure of any and all information or data files supplied with, stored on, or recovered from client equipment.

Evaluation Fees are non-refundable.


 CUSTOMER:                                                                Date                                 ,