FixmyData Work Order Form

（* Denotes required fields）

Contact Info：

Name*：

Company Name：

Diagnostic Type*：

Phone #*：

微信/QQ号码*：

Email address*：

Country*：

City：

US State*：

Address*：

Media Info：

Manufacturer*：

Model (if any)：

Serial Number*：

OS environment*：

Failure Info*：

Most Important Files and Folders Needed - ("All" or "Everything" is not accepted, please be specific):*

My data is Encrypted:

Yes No Not Sure

After a SUCCESSFUL recovery, I would like my original media to be securely recycled:

Yes No

I Agree to the Terms and Conditions

We need this form for every device