Chicago Scanning LLC - Customer Intake Form

Customer Intake Form
Date*

MonthDayYear
Date
Name*

First NameLast Name
Is this your first project with us?*

NoYes
Email - Confirm your email by entering it twice*

Confirmation Emailexample@example.com
Phone Number*
Please enter a valid phone number.
Billing Address*

Street Address

Street Address Line 2

CityState

Zip Code
My Billing Address is the same as my Shipping Address*

YesNo

TERMS AND CONDITIONS:

Cincy Scanning requires customer's credit cards to be on file for larger projects.

All sales are final. Cincy Scanning will provide adjustments and revisions when required.

The customer owns the rights to all original materials submitted to Cincy Scanning.

The customer owns the rights to all digital materials produced for them by Cincy Scanning. The customer understands that the condition of the customer's original materials will impact the overall quality of the digital images or movies.

The customer will not hold Cincy Scanning liable for items lost or damaged in the digitizing process, or by acts of God. The customer understands Cincy Scanning reserves the right to refuse the transfer of any material.

Orders estimated by Cincy Scanning to cost over $300 will require a deposit of 50% of the estimated cost to be paid in advance. The deposit will apply in full towards the final cost of the project. The final cost of a project may be more or less than the estimated amount.

Invoices paid with a credit card are subject to a 3.5% credit card processing fee. This fee can be avoided by paying with Zelle or a physical check.

Samples are available upon request and must be requested at the time of order dropoff. Samples will be billed at the standard rate upon project completion.

Unless the customer has selected the option on this intake form giving Cincy Scanning permission to dispose of their original materials, the customer agrees to pick up their completed project and original materials from Cincy Scanning's office within 30 days from the date that their final invoice is emailed.

The customer acknowledges that if they do not collect their original materials from Cincy Scanning within 30 calendar days from the date their final invoice is emailed to them, their credit card on file will be billed for monthly storage.

The monthly storage fee for physical materials that fit inside one of our small (11.50"L x 6.17"W x 4.50"H) or medium storage containers (18.13"L x 7"W x 12.25"H) is $20. The monthly storage fee for physical materials that fit inside one of our large storage bins (19.375"L x 13.125"W x 13"H) is $40.

For example, if 2 large storage bins are required to hold your physical items, your credit card will be charged $80 every 30 days until they are collected or you email us permission to dispose of your materials. If your items are left in our inventory and we are unable to charge your credit card or get in contact with you, Cincy Scanning may dispose of your original materials at our discretion.

By agreeing to these terms, you (the customer) agree to allow Cincy Scanning to charge your credit card on file in accordance with our terms.

I understand and agree to Cincy Scanning's terms and conditions*

YES
Signature*

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