This form is required to be included with shipment

Item and brand:
e.g., 4" x 12" x 3"
Number of broken pieces:
Number of missing pieces:
Estimated object's value:
Return insured amount:
Initial repair estimate cost:
50% deposit included:
Enclosed check
Paid with charge card
Repair level quoted:
Select one
Kintsugi gold effect (see examples)

Contact and Shipping Information
How did you hear about us?
Street: Cell:
Street: Phone:
Note: We do not ship to a P.O. Box

Our Contract: I agree that Lakeside Pottery Studio (LSP) will not be held liable for loss or damage of any kind during shipping. LSP use UPS Ground as the carrier and is able to insure packages up to $999. Damage or loss claim must be communicated to LSP within one week of package delivery. All packing materials must be kept for claim submission. 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, LSP 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


I read the above