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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:_____________________________ |