DVD Transfer Order Form

Print this form, fill it out clearly, sign it and send it with your order to:

Discount Duplication, 212 41st Street South Birmingham AL 35222

   Name ______________________________________

Address ______________________________________

   City ______________________________________

  State _________________ Zip ________________

Phone (      )_________________________


E-Mail ________________________________ 

If Paying by Credit Card, Circle Credit Card Type

 American Express      Discover     Mastercard      Visa

Account#____________________________ Exp. Date________ CVV Code________ Signature______________________

Please Fill Out One Order Form For Each Disc to Be Transferred

Tape Format_________________ Length of Video ________  Black Thermal Label________ #Of Extra Copies________ ($2.99 ea)

Video Tape to DVD-R Transfer $9.99 120 minutes

Please read and sign.   I authorize the above stated work to be performed. I understand that I am responsible for any royalties which may be due, for obtainingpermission to duplicate any copyrighted materials, and for the total content of the finished duplication. I do not hold Discount Duplication, Inc. liable for anything that should happen to property left due to mechanical, technical, fire, flood, or natural disaster. If paying by credit card, I authorize the charges for this service including shipping and handling to be charged to my card.

Authorized Signature________________________________ Date_____________

Follow this link if you would like a Shipping Label for your Package  

Shipping Label Link 

DVD Label Template