Video tape, CD & DVD REPAIR FORM cleaning is included with each repair

Library name: ______________________________________________________

Contact Person: ____________________________ Phone: __________________

Sent to MHLS on (date): _______________

		MHLS Use Only
	Title	Repair/Cleaning Charge $6 per item
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Total charge to be invoiced to library for Items

Print this form, complete the information on top and list the items included. Send the original with your materials. Retain a copy for your records.

Send items to MHLS Media / AV Services Department. Do not send more than 10 items at a time. No audio tapes will be accepted.
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for MHLS use only

Received at MHLS: ______ Returned by MHLS: ______Invoice #: _________