6860 Gulfport Blvd South #710
South Pasadena, FL 33707

Physical Request Form
Tel: 727-343-2735     Fax: 813-830-6032

INSTRUCTIONS: Print the form, fill it out, sign, fax us a copy at
813-830-6032 and include the original with the media/equipment you ship.


Company Name:


Telephone: Cell Phone:


Shipping Address:


Billing Address if different than shipping:


Contact Name(s):




CREDIT CARD INFORMATION:  (The credit card will not be charged unless the recovery is successful.  We accept Visa, MC, Amex, and Discover) This must be filled out. No charges are made unless recovery is successful!

Number:                                                                      Exp:

Price Quoted For Recovery:


Customer Care Technician You Spoke With:
To help HDRS, Inc, Inc and our partners better serve you and our other customers please tell us how you found us:

If On the Web Search Engine Used:

Term or Phrase Used For Search:




What Type of Media: ____ Hard Drive, ____ CD, ____ Jazz, ____ Zip, ____ Tape, ______________________ Other Can we break the seals on the media if necessary?
___ Yes (May Void Warranty of Drive)   ____ No
Operating System:


File System If Known: ( example :10 GB FAT 32 and 40 GB NTFS, if possible.)






Number of Volumes or Partitions On Media:


Serial #:


Approximately How Much Data Was on the Media?


Purchase Date of Media If Known:


What data is the most important for recovery? Folders, Directories, and Files.  (exam. My Documents) Please do not leave blank.


What media should be used to return your data?

___I wish to buy a 80gb hard drive for $119. (IDE 3.5")

___I wish to buy an external USB 2.0 80gb hard drive for $159

___I wish to buy a 120gb hard drive for $149. (IDE 3.5")

___I wish to buy an external USB 2.0 120gb hard drive for $189

___The formatted drive I have included

___DVD-ROM -First DVD is free.  Second DVD is $10.  Each additional DVD is $25. (Each DVD holds approximately 4gb of data)

(If require a different type of hard drive like SCSI or 2.5" Please call for pricing.)


Reason for Failure

The reason of Failure or In-Accessibility:


What solutions if any have already been tried to recover data on the media:



Shipping Information

Shipping Company Used:


Tracking Number:



Terms and Conditions

1. Authorization
The client authorizes HDRS, Inc, its employees, and agents, to perform any and all measures necessary to recover data from this media and or equipment.
2. Client Legal Rights
The client is the legal owner, representative, or otherwise has a legitimate right to the property or act on the owners behalf and all data contained therein sent to HDRS, Inc. 
Any property left with HDRS, Inc unclaimed for 10 days, will be disposed.
3. Liability
HDRS, Inc assumes no liability for any claims regarding the physical functioning of media and or equipment nor the condition or existence of data on storage media supplied before, during or after service.
HDRS, Inc is not liable for any direct or indirect damages, including loss of data, loss of revenue, incidental or consequential, before, during or after service and also assumes no liability for uninsured shipments.
4. Confidentiality
HDRS, Inc and its officers and employees know your data is highly confidential and will not disclose any data to any third party unless under final appeal and penalty of State or Federal Law. HDRS, Inc provides an absolute NON DISCLOSURE of any customer data.
5. Payment
Client agrees to pay in full upon completion of services rendered by HDRS, Inc, Inc. Payment is due in full upon completion of successful recovery, prior to release of data (whether shipped, picked up or downloaded). Other payment arrangements may be made prior to recovery.  If we recover the data you are looking for you must pay the price quoted for the recovery.  
We accept VISA, Mastercard, and American Express.
6. Media Warranty:
HDRS, Inc gives warranty on all return media found to be Dead on Arrival (DOA) within 10 days of shipment. Any additional warranty claims must be presented to the original manufacturer. HDRS, Inc keeps all recovered data 10 days to insure against DOA instances.
7. Shipping:
All shipping charges are the responsibility of the customer regardless of the outcome of the recovery process. In addition, to the cost of shipping HDRS, Inc, Inc. charges a $25.00 shipping and handling preparation fee. 
8. Data Recovery Guarantee:
Your recovery comes with a data guarantee. If HDRS, Inc, Inc does not recover the data as promised, HDRS, Inc will do everything possible to rectify the recovery ( including: reshipment at our cost of original drive for additional recovery attempts, etc.) or refund all or part of the recovery fees paid. HDRS, Inc retains an image of recovered media for 10 days. Any data integrity claim must be made with in 10 business days. All claims after 10 business days are null and void.

Approved By (Print):__________________________________________ Date:___________________________