Please fill in this application form as completely and accurately as possible.

Section 1 - Customer Details
Full Name:
E-mail Address:
Address Number and Street:
Address Town:
Address City:
Address County:
Address Postcode:
Contact Number:

Section 2 - Computer System Details
Computer Manufacturer:
Computer Model:
Computer Operating System:

Section 3 - Media Details
Media Manufacturer:
Media Model:
Media Capacity (in Gb):
Media Type:
IDE Hard Disk  SATA Hard Disk  External Hard Disk  Memory Stick  Flash Card  Floppy Disk
Estimated Amount of Data to Recover:
Less than 5Gb (£50)
80Gb - 160Gb (£110*)
Over 400Gb (£250*)
5Gb - 20Gb (£60)
160Gb - 240Gb (£130*)
I don't know?
20Gb - 40Gb (£70)
240Gb - 320Gb (£170*)
40Gb - 80Gb (£90*)
320Gb - 400Gb (£210*)
(* see additional costs on our charges page)
Partition Details - Is the disk partitioned? If yes please specify the number and sizes of partitions:
RAID - If the disk is in a RAID configuration please specify the RAID type and stripe size if known:

Section 4 - Data Loss Details
Please tell us how your data was lost:
Have you tried to recover the data? If so what have you tried:
Please detail the critical files you wish recovering from the drive:

Section 5 - Return Media
Return recovered data on:
New Hard Disk (supplied by customer)
New Hard Disk (bought from Home Data Recovery - see additional costs on our charges page)
DVDs ( < 40Gb only )
CDs ( < 3Gb only )

Section 6 - Terms & Conditions
Please ensure that you have read the terms and conditions before submitting this application form:
I declare that I have read, understood and agree to the terms and conditions.