Pottery made to order | repair and restoration studio in Southern Delaware
This form is required to be included with shipment

After Formal Estimate is received, fill, print, sign this form and include it with your shipment

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Item and brand:
Height:
Width:
Depth:
e.g., 4" x 12" x 3"
Number of broken pieces:
Description of damage and Comments:
Number of missing pieces:
Estimated object's value:
Return insured amount:
Initial repair estimate cost:
50% deposit included:
#
Enclosed check
Or
Paid with charge card
Repair level quoted:
Select one
Best
Mid
Kintsugi

Contact and Shipping Information
How did you hear about us?
Name:
Street: Cell:
Street: Phone:
City/State/Zip:
E-mail:
Note: We do not ship to a P.O. Box

I agree that Lakeside Pottery Studio will not be held liable for loss or damage of any kind during shipping. Lakeside Pottery use UPS Ground as the carrier and is able to insure packages up to $999. 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 is the repair cost. Repair items are for display only and can not be subjected to liquids, high temperature or scrubbing. Direct sunlight may fade colors with time. If item is sold or given to a new owner, I, the customer, will inform the new owner that the item is restored and share the above care instructions. If deposit or balance due is not paid within 30 days, Lakeside Pottery will charge a $30 monthly storage fee and has the right to sell or dispose the object. Your signature reflects your understanding of the above.

Item submitted can't be worked on without this form signed and included in shipment

SIGNATURE:

I read the above
DATE: