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Client Information

Company: Contact: Telephone: Ext:   Fax: Email: Address: City: Province: Country: United States Afganistan Albania Algeria Angola Antigua Arctic Region Argentina Armenia Aruba Australia Austria Azerbaijan Azores Bahamas Bahrain Baltic States Bangladesh Ba rbuda Belarus Belgium Benin Bermuda Bhutan Bolivia Bosnia Botswana Brazil Brunei Darussalam Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Caucasus Cayman Islands Central Asia Central African Republic Chad Chile China Colombia Comoros Congo Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Czechoslovakia Denmark Djibouti Dominica Dominican Republic Easter Island Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Fiji Finland France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea Bissau Guyana Haiti Herzegovina Honduras Hong Kong Horn of Africa Hungary Iceland India Indian Ocean Area Indonesia Iran Iraq Ireland Israel Italy Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korean Kuwait Laos Latvia Lebanon Leeward Islands Lesotho Liberia Libya Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Mali Malive Islands Malta Mariana Islands Marshall Islands Martinique Mauritania Mauritius Mexico Moldova Monaco Mongolia Morocco Mozambique Nagorno-Karabakh Namibia Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts Saint Lucia Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Atlantic Islands Spain States Micronesia Sudan Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay USSR Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands Western Sahara Western Samoa Yemen Zaire Zambia Zimbabwe Postal Code:

Job Details

Media For Recovery: Media Type:   Model:   Serial Number:

Interface Type

SCSI   IDE   EIDE   MFM   ST-RLL   ESDI   Other Controller: Computer Type: Operating System: Special Partitions or Device Drivers: Compression:    Yes  No    Describe:

Description of Failure:

Circumstances of Failure: What Recovery Attempts Have Been Made: Please List Specific Files or Folders That Are Most Needed: