Disc Repair Service Order Form How did you hear about us? Google Yahoo TV Radio Referral other Repeat Customer Same as Billing Address P.O.#    Billing Address   Shipping Address (No P.O. Box) Company Contact Name Street City, State Postcode Phone (required) 2nd Phone  Fax E-Mail    How do you plan to send us your discs?         Price Disc Transporter (No cases or sleeves) Number of discs (single sided) Qty @$2.00 each   Number of discs (double sided) Qty @$4.00 each Other Containers (CD, DVD cases, sleeves or other non-cakebox disc carrier) Number of discs (single sided) Qty  @$5.50 each     Number of discs (double sided) Qty  @$11.00 each   How many disc transporters would you like? Designed for low cost safe shipping of new or repaired discs. Strong design locks and is reusable 25 Disc Capacity   Qty @$3.50 each   50 Disc Capacity   Qty @$4.50 each   (Click Here For Total) TOTAL Return Shipping Options: (Tick one) Standard Express     Payment We do not charge your credit card until your discs are ready to ship. Shipment will occur after confirmation is made by our bank that funds have been credited. Direct deposits can cause delays of shipment of 24-48 hours or more. Payment by credit card is the fastest method - approval is instant.   Pay Method: (Tick one) Visa Mastercard Direct Deposit   Credit Card Number: Exp. Date:   Name On Card: (Please Print) Security ID: Signature: I hereby authorise you to charge my card. Please post transporters to: The Video Warehouse 13 Byron Place ADELAIDE SA 5000   1 300 360 565 www.dvdwarehouse.com.au The Video Warehouse 13 Byron Place ADELAIDE SA 5000