Disc Repair Service Order Form        Download this form in PDF  How did you hear about us? Google Yahoo TV Radio Referral other Repeat Customer Same as Bill to     P.O.#    Bill-To-Address   Ship-To-Address (No P.O. Box) Company Contact Name Street City, State: Zip/Postal Code Phone (required) 2nd Phone  Fax: E-Mail  How do you plan to send us your discs?         Price Disc Transporter Number of discs (single sided) Qty @$1.00 each   Number of discs (double sided) Qty @$2.00 each Other Containers Number of discs (single sided) Qty @$3.50 each       Number of discs (double sided) Qty @$7.00 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.) 10 Disc Capacity Item # cb_02031_3   Qty @$1.75 each   25 Disc Capacity Item # cb_01266_0   Qty @$1.75 each   50 Disc Capacity Item # cb_01267_7 Qty @$2.25 each   How many Scratch Guards would you like?           Scratch Guard (Do It Yourself) 50 Pack Item # sg_00516_7 Qty @$17.50 Per/Pk   Scratch Guard Individually Installed Item # sg_02129_7 Qty @$1.00 each   How many Security Labels would you like? Security Label (Do It Yourself) 50 Pack Item # sg_02050_4 Qty @$62.50 Per/Pk   Security Label Individually Installed Item # sg_02130_3 Qty @$2.25 each   (Click Here For Total) TOTAL Return Shipping Options Ground 3 Day Select 2 Day Air Overnight Payment We do not charge your credit card until your discs are ready to ship. Wire transfers must be made in U.S. Dollars & include all applicable charges. Shipment will occur after confirmation is made by our bank that funds have been credited, wire transfers can cause delays of shipment of 24-48 hours or more. Payment by credit card is the fastest method, approval is instant. Call me with total (including shipping cost) please   I authorize you to add shipping costs and ship immediately   (This is the fastest method as we only call you if there is an issue with the credit card you provided.) Pay Method Visa Mastercard Discover American Express Wire Transfer Credit Card Number: Exp. Date Name On Card: (Please Print) Security ID Signature: I hereby authorize you to charge my card. This Sale is subject to Azuradisc standard Terms and Conditions of Sale Please ship transporters to: Azuradisc 2885 N. Nevada St. Suite #140 Chandler Arizona 85225 USA 1-800-WE-FIX-CDS www.azuradisc.com (Printing indicates you agree with this Contract)