Customer Name (print)____________________ Customer Phone ________-_________-__________ Customer Cell (if available) ________-_________-__________ Customer Email__________________________________________ List what is wrong with your Playstation below: Customer Signature_____________________________ Date_______/_______/______ By signing the above customer signature you accept the following terms: You give me permission to take your Playstation apart. I can not be held responsible for your broken Playstation. Repairs may void any warranty you may have on your game console. $19.99 repair fee, only charged if your Playstation is repaired. $4.99 service fee $9.99 shipping fee will be charged for shipping. If I can not fix your Playstation, and you made your payment using Paypal, I will need to deduct a small fee from your returned repair fee. You will need to pay for any new parts I install in your Playstation. -------------------------------------------------------------------------------------------------- (STOP DO NOT FILL OUT BELOW) Date of completed repairs________/_______/_______ Total Charges for Repairs- $______________ |