Azuradisc


Disc Care & Repair Made Simple

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Disc Repair Service Order Form

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.)

25 Disc Capacity Item # cb_01266_0	Qty	@$1.75 each
50 Disc Capacity Item # cb_01267_7	Qty	@$2.25 each
100 Disc Capacity Item # cb_01268_4	Qty	@$3.95 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_00516_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_02050_4	Qty	@$1.85 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)