$300 Data Recovery - Hard Drive Destruction Form

First Name*

Last Name*

E-mail*

Confirmation Email*DO NOT use @sbcglobal.net or @att.net e-mail addresses (their spam filter will not let our e-mails through).

Phone Number*

Area CodePhone Number

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Manufacturer:*

Model:*

Enter device(s) serial number (if unsure, write some unique number from the drive's label):*

Manufacturer:

Model:

Enter device(s) serial number (if unsure, write some unique number from the drive's label):

Manufacturer:

Model:

Enter device(s) serial number (if unsure, write some unique number from the drive's label):

Manufacturer:

Model:

Enter device(s) serial number (if unsure, write some unique number from the drive's label):

Manufacturer:

Model:

Enter device(s) serial number (if unsure, write some unique number from the drive's label):

HARD DRIVE DESTRUCTION TERMS & CONDITIONS (Check ALL to indicate you agree)*

I am the owner of all devices listed.The items listed were delivered to a $300 Data Recovery representative.I am authorized to request destruction of the devices listed.The listed items are intended to be destroyed, and cannot be returned with data intact under any circumstance.$300 Data Recovery will not assume responsibility for sensitive data present on devices collected for destruction.$300 Data Recovery cannot validate that all data has been completely erased from submitted devices.$300 Data Recovery will handle and store all devices submitted for destruction as if it contains sensitive data.Once $300 Data Recovery collects devices, the data on the media should be considered to be destroyed and completely unrecoverable.

Signature*

Today's Date*

MonthDayYear

reply to email