Mail Order Form
Name____________________________________
email______________________________
Address__________________________________
_________________________________________
Date______________________________
Phone (day)______________________________
Phone (evenng)____________________________
Signature__________________________
Please Note: We assume responsibility for the care of your parts while in our shop In case of
accidental damage, the item will be replaced in kind or funds, our choice.
Payment: Money Orders (to Michael L. Pierich), or by credit card online via Paypal
(http://www.paypal.com) .Note: Paypal payments subject to 3% service charge applied to
total price plus shipping.
Cash accepted for local work. When work is complete, you will be notified via email or phone of
the balance due including shipping. Mail money orders to: Mike's Polishing, c/o M. L. Pierich,
3776-b Powell's Valley Rd., Halifax, Pa 17032. Paypal payments to mike@mikespolishing.com.
Shipping: When shipping items, please pack securely.. Return shipment will be via Fed Ex or
Parcel Post. If you would like insurance on your shipment (for an added charge), please indicate
below..
Condition: We cannot repair large chips, broken corners, etc. Porous aluminum and brass will
take a high luster and look very acceptable,, but pores will still be visible under close examination.
We cannot be responsible for removal of such a condition, which is often mistaken for "pitting".
Also, the removal of large deep gouges could weaken the part due to material removal. If you are
concerned about this, please note below and we will remove all but the worst defects. Your fee
will be adjusted accordingly
Please list items you are shipping. Include serial numbers if
applicable
ITEM(S) DESCRIPTION
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__________________________________________________________________________________
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If you have already received a price quote, please indicate amount and date______________________
Would you like insurance on return shipment? (Y/N)_________
Please include this signed form with your shipment. Keep a copy for your records.
Ship to:
Mike's Polishing
c/o
M.L. Pierich
3776-B Powell's Valley Rd.
Halifax, Pa 17032
Please print and fill in this form.
717-877-3168 www.mikespolishing.com Halifax, PA
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