Film Transfer Order Form

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

Discount Duplication, 240 Oxmoor Circle, Suite 102, Birmingham, AL 35209

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______________________

8 mm & Super 8 16mm
_________ # of 50 ft reels (3 in.) _________ # of 50 ft reels (3 3/4 in.)
_________ # of 200 ft reels (5 in.) _________ # of 100 ft reels (5 in.)
_________ # of 300 ft reels (6 in.) _________ # of 400 ft reels (7 in.)
_________ # of 400 ft reels (7 in.) _________ # of 1600 ft reels (13 3/4 in.)

Please number your reels in the order you would like them to appear on your tape or check here ___ No particular order

1 DVD-R Digital Disc Master Included

___ Basic (Silent) ___ Standard (Music)

______ # additional viewing copies for friends and family members, DVD $2.99 each

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 obtaining permission 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 for any reason you should pick up your film without purchasing the film transfer, you will be charged for film editing, splicing, reels, cleaning and technician labor. Reels $2.00 each, splices $1.00 each, editing labor $50.00 per hour.

Authorized Signature_____________________________  Date_____________

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