Video Conversion Letter of Ownership

I _____________________________________  _____________________________________ have purchased and own the
                          (First)                                                              (Last) 


video tape titled ___________________________________________________________________________________________


_________________________________________________________________________________________________________


The above video tape is recorded in a foreign system that can not be viewed on my television. The video conversion will be for

 my home use only.


WE DO NOT CONVERT ANY DISNEY VIDEO

**** Failure to complete and sign this form will delay your order. ****
Add $5.00 for CG bybass, filtering or stablizing.



Sign Here:_____________________________