ORDER FORM
Reface Industries Pty Ltd
107 Kew Street
WELSHPOOL, 6106
Western Australia

Tel: (08)
9472 8888
Fax: (08) 9472 8866

 
 Order Information
 Media No of Discs

Price

Total

Audio CD   $5.00 each  
CDR/CD-RW DVD-R   $5.00 each  
Dual Sided DVD's   $8.00 each  
DVD Discs   $6.00 each  
Game Discs   $8.00 each  
PC and MAC Software   $10.00 each  
   

Shipping:

$1.00

    Total:  
 
 Shipping Information
 
First Name:  
Last Name:  
Address:  
   
Suburb/City:  
State:  
Country:  
Postcode:  
Phone:  
Email:  
 
 Payment Information
 
I enclose a cheque/PO for $___________ (made to Reface Industries Pty Ltd)

or Please debit my credit card: $__________  Mastercard   Visa Bankcard

Cardholders Name:___________________________________________________

Card Start Date:      Expiry Date:        Issue Number:

Card Number:  

Disclaimer
I authorise Reface Industries Pty Ltd to repair the enclosed discs.  I understand that certain label damage is not repairable and/or it may not be possible to completely repair these discs.  Reface Industries is not financially responsible for any customers discs that are lost or damaged during shipping.  My signature represents my agreement with these terms and conditions.

Signature________________________________       Date: ____/____/________