video conversion order form

If Paying by Credit Card Circle Credit Card Type

American Express Discover Mastercard Visa

Account#_________________________________

Exp. Date________

Signature______________________

__________ # of Tapes to Convert     __________Length of Video     __________ # of Copies of each tape

__________ Check here for DVD-R Conversion (cost $14.99 one hour / $19.99 two hours)

__________ Check here for run time (measure length of video if unknown) (cost 99 cents)

______________________ Country tape or disk was made in            ______________________ Country tape or disk is to be viewed in

****  Failure to complete and sign this form will delay your order. **** *DVD-R's are not guaranteed to play on the older dvd players. We are unable to refund payment due to incompatibilities with DVD Players *NO DISNEY OR PORNO PLEASE

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. If copyrighted tape, I have purchased and own this video for home use only. Please convert this tape for viewing on my tv.

Authorized signature__________________________________________________  Date_____________

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