| Send to: | |
| Address: |
Office in Ontario - Toronto510 Champagne Drive
Toronto, Ontario M3J 2T9 Canada |
| Distance: |
Data Retrieval Canada
Office in Ontario - Toronto510 Champagne Drive
Toronto, Ontario M3J 2T9
Canada
Data Retrieval Canada
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 866-519-0216.
I, $f_name $l_name, authorize Data Retrieval Canada 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
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Name: |
$f_name $l_name |
Type: |
$media_type |
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Company: |
$company |
Manufacturer: |
$manufacturer |
|
Address: |
$address, $city |
OS: |
$os |
|
E-mail: |
Capacity |
$size | |
|
Phone: |
$phone |
|
|
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| Subtotal: | $quote_currency $quote_subtotal | ||
| Tax: | $quote_currency $quote_tax | ||
| TOTAL: | $quote_currency $quote_total | ||
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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 Data Retrieval Canada 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.
| Image | Product name | Quantity | Total price | Delete |
|---|
| Subtotal | |
| Tax | |
| TOTAL |
Data Retrieval Canada
Office in Ontario - Toronto510 Champagne Drive
Toronto, Ontario M3J 2T9
Canada
Data Retrieval Canada
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 866-519-0216.
I, $f_name $l_name, authorize Data Retrieval Canada 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 |
OS: |
$os |
|
E-mail: |
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 Data Retrieval Canada 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.





