Tape Unit Repair Request Form

IMPORTANT NOTE:

Please complete the entire form. If information is missing your repair may be delayed.

 Customer information (Your unit will be returned to this address)

*NOTE: Please give a street address.
Shipping services such as Airborne, FedEx, and UPS do not ship to a Post Office box.

List additional people and their phone numbers whom we may contact about the repair and who may contact us.

Do you want us to call you after evaluating the unit?

By default, the technician will only contact you after evaluating the drive if it appears that the drive cannot be repaired.

Do you want priority service? (optional)

Priority Service repairs are processed in the order in which they are received and are placed ahead of Standard repairs. There is a $50 bench fee for Priority Repairs canceled after work has begun.

Do you want important data copied onto a CD or Zip disk after the repair? (optional)

By default, your drive is returned so that you can access the data on the drive. If you want some data written to a backup disk for safety purposes you can choose one of the options below.

Total Estimated Charges:

Payment Method(choose one)

Please specify a payment method. Your request will only be placed in line and eligible to be worked on when a valid payment method has been received.

NOTE:
Applicable local taxes may be added to the charges.

Cardholder Name: ________________________________________.

Credit Card Number:________________________________________.

Exp Date:_______/_______.

[ ] CHECK
The check must be numbered, imprinted with your name and address, signed, and made out to Mobile Tech Corporation. An original check must be received.

[ ] PURCHASE ORDER P.O.# ____________________________________
Mobile Tech Data Recovery does accept purchase orders as payment for services. If you decide to pay by purchase order, then the repair will become eligible to be worked on only when a purchase order has been received that meets the following conditions:

1. The Purchase Order must be titled "Purchase Order."
2. The Purchase Order must be numbered.
3. The Purchase Order needs to specify that payment Terms are Net 30 Days.
4. The Purchase Order requires both a Bill To Address and a Ship To Address.
5. The Purchase Order amount needs to be specified in US Dollars.
6. The Purchase Order must be signed with an authorized signature.
7. The line item should be "Repair Service."
8. Specify FOB Mobile Tech on the Purchase Order.

After you have created a Purchase Order please send it with these forms and the drive. If you have already shipped the forms and the drive you may email your Purchase Order to support@mobiletechcomputer.com

Return shipping payment (choose one):

If we are shipping anything to you, you must include an account number or payment for the return shipping.

[ ] Airborne Express [ ] UPS [ ] FedEx

Account number: _________________________.

[ ] Visa [ ] Master Card

Cardholder Name: __________________________________________________.

Credit card number: __________________________________________________.

Expiration Date: __________ / __________.

Return shipping method (choose one)

[ ] Airborne Express Overnight Air Express Service
[ ] Airborne Express Next Afternoon Service
[ ] Airborne Express Second Day Service

[ ] UPS Next Day Air with Saturday delivery
[ ] UPS Next Day Air without Saturday delivery
[ ] UPS Next Day Air Saver
[ ] UPS Second Day Air

[ ] FedEx Priority Overnight
[ ] FedEx Standard Overnight
[ ] FedEx 2nd Day (Economy)

Return shipping insurance (choose one)
Mobile Tech is not responsible for any damages and theft incurred during shipping. Check one of the following:

[ ] I am purchasing shipping insurance from the shipper (Airborne, UPS or FedEx). I fully understand the coverage this insurance provides. (Only covers replacement of hardware, not data.)
Value of hardware shipped: $__________
[ ] I am declining shipping insurance. Mobile Tech will not be held responsible for any damages and theft that occur in transit.

NOTES:

1. UPS and FedEx will not accept purchase orders or checks for shipping charges.
2. Mobile Tech is not responsible for any charges, damages or theft incurred during shipping.
3. Packages mailed to an international address will be given the shipping method closest to the one requested.
4. Any customs duties, taxes, or tariffs that occur in international shipping are to be paid by the customer.
5. International customers using DHL must, on the DHL shipping forms, accept customs duties and tariffs for shipment in both directions. (Unless you specify otherwise, DHL charges customs duties to the receiver). Mobile Tech will not pay customer's duties on packages sent for data recovery. If you send an international package and you didn't accept customs duties and tariffs on the DHL shipping forms, then Mobile Tech will either refuse your package and return it to you, or Mobile Tech will charge the cost of your customs duties and tariffs to your credit card when Mobile Tech is billed.
6. International customers using FedEx for return shipping need to provide their FedEx account number. FedEx charges customs duties to a FedEx account number. If a FedEx account number is not included for return international shipping, then Mobile Tech will not be able to return the package through FedEx.

WAIVER OF LIABILITY

I, ______________________________________, grant permission to Mobile Tech Corporation ("Mobile Tech") to perform any action they deem necessary to attempt to repair my unit. I understand that this procedure is a final attempt towards the repair of the unit and could result in loss of part, or all, of the data stored thereon and that Mobile Tech makes no warranty or guarantee as to the success of its attempts. Furthermore, I release Mobile Tech from any liability for any data loss which may occur during, or as a result of, this procedure. I also release Mobile Tech from any liability for any theft, damage or destruction to the drive and any other hardware, diskettes, or other media sent to Mobile Tech in connection with this Waiver. ALL CLAIMS FOR LIABILITY AND/OR LOSS INCLUDING WITHOUT LIMITATION ANY INDIRECT, INCIDENTAL OR CONSEQUENTIAL DAMAGES WHICH MAY OCCUR AS A RESULT OF ANY Mobile Tech ACTION (OR INACTION) ARE HEREBY EXPRESSLY WAIVED. I also understand that, even if the drive is successfully recovered, there is a possibility that individual files and directories on the drive may still be inaccessible due to the type of damage originally sustained. In addition, I agree to pay the applicable fee for these services by Mobile Tech, plus shipping and handling expenses as follows:

Mobile Tech does not pay for return shipping. Shipping insurance and other expenses are the undersigned's responsibility.

I agree to accept the responsibility for shipping the system or unit to Mobile Tech. Mobile Tech will not be responsible for any damages and theft incurred during the shipping process and any loss or claim against such agents shall be solely by and on the behalf of the undersigned.

I agree to all of the foregoing conditions.

Declaration of ownership and authority

I, ___________________________________, am the legal owner of the hardware described below and/or am the duly authorized representative of
__________________________________________________
(Company name if hardware is owned by corporation, agency, etc.)
My signature will attest to the fact that I am the legal owner, or an officer of the above named company, or am empowered by its governing body, to act in its behalf for matters relating to the attached Agreement in regard to the property identified above.

Hardware description (make/model, serial number, and so on):

____________________________________________________

____________________________________________________

Please answer these questions to the best of your ability:

1. Does the drive appear to be physically damaged? _____Yes _____ No
2. What Operating System was on the computer?

   __DOS / Windows 3.x
   __Windows 95
   __Windows 98
   __Windows NT
   __Windows 2000
   __Windows 2003
   __Windows XP

3. Please explain the symptoms of the problem. Also, describe what has been done to attempt to fix the problem. Please use additional pages if necessary.
4. What kind of computer was the drive in?

   ____XT/AT ____386 ____386 ____486 ____Pentium

5. Is the hard drive from a Name-Brand computer such as Compaq, Dell, or Hewlett-Packard?

   Brand of Computer:____________________________.

Tape Unit Repair Shipping Instructions