Total Golf Cub Repairs.com

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Please print form below and mail, with club(s) to mailing address.
Total Golf Club Repairs
Repair Form
 Mailing Address: 1208 Orchid Circle. Bellport, NY 11713
Phone: (631) 654-5999
    You can also Pay Through Pay Pal



    *Full Name:___________________________
    *Account Number:____________________________
       (If Applicable)
    Money Order or Cashier's Check
           (No Personal Checks Please)

    Credit Card (Complete Information Below)

    		 *Company:_____________________
    *Credit Card :_________________
    (i.e. Visa, M.C., AMEX, Discover)

    		 *Credit Card Number:_____________________________
    *Expiration Date:______/______

    		 *Security Code (CIV):_________
    *Address:___________________

    		 *City:_____________________
    *State:___________________

    		 *Zip:____________
    *Phone:________________________
    		 *E-Mail:___________________________

    Please Provide Instructions for Repair:
    ________________________________
    ________________________________
    ________________________________
    ________________________________

    		Please List all Clubs Included in This Shipment:
    ______________________________________
    ______________________________________
    ______________________________________
    ______________________________________

    Ship All Clubs to The Address provided Above.

    Return Shipping (Continental U.S.)

    Regular UPS FREE (US customers only)

    2nd Day Air $35

    Overnight $55



    Shipping Insurance* (Check One)

    $0-$100 No Charge
    $101 - $200 Add $1.95
    $201 - $300 Add $2.25
    $301 - $400 Add $2.60
    $301 - $401 - $500 Add $3.90


    All Completed Club Repairs Will be Shipped Via UPS Ground Unless Otherwise Requested.

    *If You Require the shipment to be insured for a specific value, please check the appropriate box or state the amount on the repair instructions. You will be billed for the insurance rate as provided by the carrier. If you choose not to have the shipment insured, please be advised that UPS will only cover $100.00 of your losses.

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