_____________________________________
Name
_____________________________________
Phone # (Cell If Possible - Quick/Direct Contact is Best)
_____________________________________
Email - Print Clear Use PayPal e-mail if possible for faster service!
o No images recovered means No charge*
o Image recovery fees will be charged if ANY images are recovered. All recovered images burned/saved to a CD & returned
o *$20.00 fee is charged for ship/analysis on each order. (Include cash when shipping if possible or make check to eProvided.com) (Separate from Recovery Fee)
o *$150.00 fee for RUSH ORDERS (send in with media - optional, Separate from $20.00 Shipping)
o eProvided is not responsible for lost cards mailed improperly, protect your shipment by wrapping card properly with bubble-wrap or a protected envelope. Shipment tracking is available per request only & for an additional fee.
File Information
App. how many images were lost? ________
____________________________________ (Important)
Camera/Device make/type/model (i.e. Canon D-43)
____________________________________
Describe what happened above (More room use back)
____________________________________
Setting of pictures? (Vacation, Shoot, Work, Home.)
Media was formatted since noticing the missing images? Y N
New photos saved to media since noticing lost images? Y N
Recovery attempts have already been made on this card? Y N
Don't call/e-mail for status/shipping updates, we'll notify you per our turn-around time above. Recovery can't be guaranteed, data may be corrupted past a point of salvation. I understand I'm in no way guaranteed any files will be recovered from supplied media regardless of any expressed or implied comments. I've read eProvided's "Policies, Terms Conditions" linked on the eProvided homepage & agree to all terms & conditions. I understand there are recovery as well as ship/hand/analysis fees. I've read this entire form. I indemnify, defend, & hold harmless eProvided for any & all liability, demands, actions, liens, losses, damages, costs, judgments, & expense, including reasonable attorney's fees arising out of or resulting from any eProvided services. I authorize eProvided to bill me for services rendered if any images are recovered. (We use PayPal or will accept a check/CC's)
_______________________
_______________
Signature Date
(mm/dd/yy)
Name (First, Last): __________________________
Street Address:____________________________
City:_________________ State:_____ Zip:______
How did you find us? (Please Circle One )
o Friend / Associate / Other / Sponsored Listing On Search Results
Camera Store
News Story | 
Magazine - Time Magazine | PcPhoto | Popular Mechanics | Time
Search engine: Google | Yahoo! | AOL | AskJeeves | MSN | Other _________
o Paypal.com Uses: Visa-MC-AMEX-Disc. ___
o Check ___
eProvided. Com
5485 Spur Cross Trail - Parker, CO 80134
Attn: Media Recovery
eProvided provides a complete reformatting of your card & a comprehensive diagnostic examination; restoring it to like-new condition. First, we perform a complete Diagnostic scan on your media card, testing for erroneous memory blocks or other troubles. Then, we use an wiper program to zero out all data on your card. Third, we perform a “Scandisk” check & a low-level Digital-Memory Format formatting all card sectors while repairing any/all errors. Last but not least; Full Diagnostics, read/write block-data test, to assure the card is performing flawlessly. eProvided's lifetime recovery option would provide free lifetime recovery for this particular card. If your card were to fail again for any reason, simply send it to eProvided.com for a FREE no questions asked file recovery service!
I want my images available/delivered immediately online after recovery. (Recover images, send email with link to images downloadable online [Add $16.50])
Rejuvenate my memory card [Add $11.99] Restores media card to original factory settings in case of format or card error issues. (If Recovering Images/Data; Recovered Images/Data Returned on Cd-Rom/DVD)
Rejuvenate (see above) & guarantee the card with your free lifetime recovery & rejuvenation service [Add $19.99] (If Recovering Images/Data; Recovered Images/Data Returned on Cd-Rom/DVD)
Create an Online Photo Album of my Recovered Images I'll Show Friends & Family (Click for Sample Before Printing Form) [Add $39.99]
$10.00 off recovery fees when recycling cards no longer trusted. By checking here I understand I will pay $10.00 less and eProvided will keep my card/stick/device. Not valid for CD or DVD plastic media type disks.
No I'm not interested in any services above, recover my files & return my card as is; I understand the images will be placed on a CD-Rom.