Please fill, print and sign this page and include it with your shipment.
Press "Tab" to go to the next field
e.g., ceramic doll by Hummel, sculpture, pottery
* Item and brand:
* Width:
* Depth:
* Height:
e.g., 4" x 12" x 3"
* Number of broken pieces:
Description of damage and Comments:
* How many pieces are missing:
*Estimated value:
Note:
Paying online will include 3% charge card fee
*Required shipping insurance:
*Initial repair estimate:
*Preferred carrier:
e.g., UPS, FedEx, US Post Office
Contact and Shipping Information
How did you hear about us?
* Name:
* Phone - Day:
* Street:
* Phone - Eve:
Street:
* E-mail:
* City/State/Zip:
I agree that Lakeside Pottery LLC will not be held liable for my above listed items’ loss or damage of any kind during shipping. Postage (UPS, Fed Ex, etc., or US Postal) may cover up to but not over $500 for ceramic items or antiques. If you do not instruct Lakeside Pottery of your preference for carriers and insurance amount, Lakeside Pottery will choose UPS Ground with $100 insurance coverage. Shipping costs and CT sales tax (for CT customers) will be added to the total restoration cost. Items restored will resemble the original look as close as possible. Some repair traces might be slightly visible if inspected closely. If repair is not satisfactory, the maximum liability for Lakeside Pottery LLC is the repair cost refund. Repair items are for display only and can not be used functionally, be subjected to liquids, high temperature or scrubbing. Lakeside Pottery LLC might sale or dispose the restored item if not fully paid within 30 days of invoice submission. Your signature reflects understanding of the above disclaimer and a copy of this form will be kept on file.
Item(s) submitted will not be worked on without this form signed and included in shipment.
