Data destruction intake form

This certifies that RealTime, LLC received from the authorized business representative below the following items for degaussing, which will render the drive unusable and follow on physical destruction. Inventory below was confirmed by a RealTime, LLC representative.

Business Name:	Primary contact:
Physical Address	Email Address:
RealTime Rep:	Received Date:

List of hard drives to be destroyed

COMPUTER MAKE & MODEL	COMPUTER SERIAL NUMBER	PART NUMBER if applicable	HDD SERIAL NUMBER if original system SN unavailable	HDD WIPED?

Instructions: Businesses should make 3 copies of this form with computer info filled out list: 1 for your records, 1 for RealTime, and 1 to be appended to the Unicor certificate of destruction.

Hard Drives will be secured at RealTime until final physical destruction at the Unicor Facility in Marianna, FL within 1 week. Remainder of the computer will be disposed of via electronics recycling program. Businesses will receive the final destruction certificate for your records from RealTime, LLC in 1-2 weeks after initial drop off.

Questions? Contact RealTime, LLC at 334-678-1417