First Name: (*) |
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Last Name: (*) |
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City: |
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State: |
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Phone Number: |
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Alt. Phone Number: |
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Email: (*) |
Please let us know your email address. |
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How would you like us to contact you? |
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Drive Make: |
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Drive Model: |
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Operating System: |
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Drive Size: |
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Is this a Server? |
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Level of Urgency: |
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*Typical recovery turnaround time. Results may vary. |
What is Failure Symptom? |
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Briefly explain the Failure: |
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Have any of your drives been opened or have any components been swapped? |
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If "YES" please explain: |
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Please Type the Following Four Letters |
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