Please Print out the form on-line then sign it and send it to us with your hard drive(s)from which you need media load to secure storage lockers. PLEASE CUT THE SHIPPING ADDRESS LABEL AT THE BOTTOM AND STICK IT ON YOUR PACKAGE. DO NOT SEND ANY MEDIA IN JIFFY BAGS. USE WELL-PADDED BOXES ONLY.
Note:
Once the package has been shipped please send an email to support@BIPmedia.com along with your reseller site ID and include the package tracking number so that we can pre-book your hard drive load request.
If you have any questions or you want to discuss a specific case, please contact support@BIPmedia.com
CONTACT INFORMATION:
Company Name:
Contact Name:
Email Address:
Telephone Number:
Extension:
Mobile:
Address:
Street:
Town:
County:
Post Code:
|
MEDIA FOR DATA LOAD: (Please tick box as appropriate)
Internal Hard Drive 
External Hard Drive
DVD
Model Number (if known):
Serial Number (If known):
|
Operating System (tick as appropriate):
DOS
Windows 95
Windows 98
Windows ME
Windows XP
|
Windows 2000/2003
Apple
Mac
Linux
Not Known
|
Quantity:(How many are you sending us?)
Most important accounts you want loaded:
Please list the accounts you setup on-line and have loaded on the hard drive(s) you are sending. If you need additional room attach a blank sheet with the remainding accounts.
01.
02.
03.
04.
05.
06.
07.
08.
09.
10.
11.
12.
13.
14.
15.
|
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
|
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
45.
|
1.Authorization
- The Reseller authorizes BIPmedia or its agents to load the media sent to customers on-line secure storage locker account.
- The Reseller authorizes BIPmedia, its employees, independent contractors, and agents, to receive and transport this media/equipment/data to, from and between their facilities.
- The Resellers hereby represents, warrants, and affirms that he, she, or it is the owner or the authorized representative of the owner of the property and all of the information and data stored on said property. By asking BIPmedia to enter into this agreement with you, as Reseller, you declare that the foregoing representations are true and correct. You agree to indemnify BIPmedia for any claims against BIPmedia related to this data load.
2.Failure to claim property
- Any property left with BIPmedia unclaimed for 30 days, will be disposed or recycled. At which time, BIPmedia shall have no liability to the Reseller or any third party.
3.Limited Liability
- BIPmedia shall not be liable as a result of this agreement or the performance of any data load services or evaluation of the possibility of providing data load services, for any claims regarding the physical functioning of equipment OR media or the condition or existence of data on storage media supplied before, during or after service.
- THE RESELLER UNDERSTANDS THAT DATA LOADING CANNOT BE GUARANTEED.
- IN NO EVENT WILL BIPMEDIA OR ANY CONTRACTOR, EMPLOYEE, OR AGENT OF BIPMEDIA BE LIABLE FOR ANY LOSS OF DATA OR LOSS OF REVENUE OR PROFITS OR ANY SPECIAL, INCIDENTAL, OR CONSEQUENTIAL DAMAGES, HOWEVER CAUSED, IN CONNECTION WITH THIS AGREEMENT OR ANY SERVICE PROVIDED BY BIPMEDIA OR ITS AGENTS, CONTRACTORS, OR EMPLOYEES -- EVEN IF BIPMEDIA HAS BEEN ADVISED OF THE POSSIBILITY OF DAMAGE OR LOSS TO PERSONS OR PROPERTY.
- BIPmedia's liability of any kind with respect to the services, including any negligence on its part, shall be limited to the contract price for the services.
Reseller and BIPmedia agree that the sole and exclusive remedy for unsatisfactory work or data shall be, at BIPmedia's option, either (a) additional attempts by BIPmedia to load satisfactory data or (b) a refund of the amount paid by the Reseller. The parties acknowledge that the price of BIPmedia's data load services would be much greater if BIPmedia undertook more extensive liability or promised additional remedies.
- Reseller is aware of the inherent risks of injury and property damage involved in data loading, including without limitation, risks due to destruction or damage to the media or data and inability to load data, or inaccurate or incomplete data load, including those that may result from the negligence of BIPmedia, and assumes any and all known risks of injury and property damage that may result.
4.Confidentiality
BIPmedia agrees not to disclose any and all information or data files supplied with, stored on, or loaded from Resellers equipment except to employees , independent contractors, lawyers, or agents of BIPmedia subject to confidentiality agreements or as required by law.
5. Payment
Payment is due in full upon completion of successful load, prior to release of data (whether shipped, picked up, downloaded or streamed), unless by special previous arrangement.
The Reseller agrees to pay for data load even if BIPmedia has partially loaded the data.
No-data no-fee applies only when no data load is possible.
The Reseller is financially responsible for all shipping costs, custom duties and taxes to and from BIPmedia.
We ONLY accept VISA, MasterCard, PayPal and cash. American Express is accepted subject to a 5% surcharge
6. Warranty
BIPmedia makes no warranty, express or implied, and BIPmedia disclaims any warranty of any kind, for the services being provided or discussed hereunder.
|
Approved by:
Date:
Signature:
|
PLEASE CUT AND STICK ON YOUR PACKAGE
Ship From:
Name:
Address:
City:
State:
Zip:
Ship To:
P.O. #73
GLEN HEAD
UNITED STATES
CONTACT NAME: ATTN: RECEIVING
CONTACT NUMBER:
Notes:
JUKEBOX STEAMING SETUP + MEDIA LOADING
|
ACCT#
|
CARTON ID:
|
|