Chicago Data Recovery Corp

Service Agreement and Charge Authorization Form

To authorize charges on your credit card for Case $service_number, please print, sign and fax this form back to 1-866-857-1183.

I, $f_name $l_name, authorize Chicago Data Recovery Corp to charge my credit card in the amount of $quote_currency $quote_total (PLUS SALES TAX WHERE applicable) for the services/products listed below.

I understand that this fee does not include charges that will apply for data recovery service. This fee is non-refundable is not contingent on the success of a potential recovery. *

I acknowledge that there is a service surcharge, in addition to the total recovery cost, if I purchased any of the following services:

• Premium Service - add 10% to final service fee
• Premium Plus Service add 20% to final service fee
• Advantage Service add 30% to final service fee
• Emergency Service add 40% to final service fee
• Premium Emergency Service add 50% to final service fee
• Specialized Emergency Service add 50% to final service fee

Name:	$f_name $l_name	Type:	$media_type
Company:	$company	Manufacturer:	$manufacturer
Address:	$address, $city $zip, $state	OS:	$os
E-mail:	$email	Capacity	$size
Phone:	$phone
Subtotal:	$quote_currency $quote_subtotal
Tax:	$quote_currency $quote_tax
TOTAL:	$quote_currency $quote_total

Credit Card: MasterCard / Visa / Discover / American Express (circle one)
Credit Card Account Number: - __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Exp/Date ___ / ___

Three Digit Code __ __ __ (American Express Four Digits) __ __ __ __

Signature: _________________________ Date: _________________________

By signing this Service Agreement and Payment Authorization I agree to the terms and conditions specified in this form.

* You can be confident that Chicago Data Recovery Corp will make every possible effort to perform your recovery within the estimated time frame for the service you chose to proceed with. However, please keep in mind that data recovery is not an exact science. Due to unforeseeable logical and mechanical complications, some recovery cases may take longer that originally estimated.