13/03/2017 Approved Recovery Efforts Authorization

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APPROVED RECOVERY EFFORTS AUTHORIZATION

Please complete the informa on below:

ACKNOWLEDGEMENT
IA authorize Proven Data Recovery to proceed with data recovery eorts at a cost of
Enter Amount + applicable tax in the event of a successful recovery for Enter Case ID . If indicated payment below is not received
within 5 days of the completed recovery, we will automa cally charge the credit card on le. **You will not be billed un l comple on of data recovery services or
as otherwise provided in the Data Recovery Terms and Condi ons you previously executed. We are holding your card in case of non-payment.**

What turn around me are you selec ng for this case (refer to original quote)? *

Standard Expedited Emergency

What is your preferred method of payment a er the recovery? *

Credit Card Bank Transfer (2% discount - Encrypted link provided on invoice) PO

BILLING ADDRESS

Company Name:

Country: *

Billing Address: *

City: *

State: * -SELECT-
Zip Code: *

Phone: *

CARD DETAILS
*Credit card informa on is required regardless of which payment method is selected above*

Card Holder First Name: *

Card Holder Last Name: *
Credit Card Number: *
Expira on Date: *
CVV2 Security Code: *
Email Receipt To: *

ADDITIONAL QUESTIONS
Is your organiza on Tax Exempt? If so please enter tax exempt number here.

Will you be providing a review of your experience (We will send you a gi card for helping us improve our services. Review link will be sent a er recovery)?

Yes No

I authorize Proven Data Recovery to charge the credit card indicated in this authoriza on form according to the terms outlined above. This
payment authoriza on is for the goods/services described above, for the amount indicated above, and is valid for the en re balance in the
quote that was sent to you. I cer fy that I am an authorized user of this credit card and that I will not dispute the payment with my credit card
company; so long as the transac on corresponds to the terms indicated on this form. I agree to pay any reasonable collec on and a orney fees
in the event the amount indicated is not paid in full.

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13/03/2017 Approved Recovery Efforts Authorization

eSignature: Type Your Full Name To Sign

Date: (Will ll automa cally):

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