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DVD / CD / GAME DISC REPAIR FORM

PRICING INFORMATION
Qty Discs Pricing

Subtotal
               x

ONLY $2.99 PER DISC
  Subtotal
  Return Shipping:  Media Mail
7 - 10 Days		 $1.99
  Priority Mail
2 - 3 Days		 $4.99
  Total Order
     

 

SHIPPING INFORMATION
Company Name:
First & Last Name:
Street Address:
 
City:
State:
Zip Code:
   
Telephone:
Email:

 

PAYMENT INFORMATION
Payment by:
Card Number:
Expiration Date: /

CVV:

Click here for sample
Name on Card:

* For customer protection, we will ship discs to address which is filed with your credit card company.
We will not repair or ship out any discs if there is no address verification approval.
Please provide us with accurate information to avoid chargebacks.
 


I authorize Fastlane Video to charge my credit card & to repair the enclosed disc(s). I understand that certain label side scratches are not repairable and/or it may not be possible to completely repair these discs. Unless insured, Fastlane Video is not financially responsible for any customer’s disc(s) lost or damaged in return shipping. Fastlane Video bears no responsibility for customer’s disc(s) other than proper repair and return shipping. No dollar value may be assigned to any CD damaged during repair. Fastlane Video is not responsible for the contents of any disc shipped to us and will comply with federal and state laws where applicable. My signature represents my agreement with these terms and conditions.
 

Signature ________________________________________     Date ___________

 

Please print the form, fill it in completely, and mail it with your discs to:

Fastlane Video
12726 Hadley St. #102
Whittier, CA 90601
(562) 698-3313