Reface Industries - Order Form

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: ____/____/________