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________ | Signature______________________ |
VHS conversion rate: $9.99 up to 2 hours and $14.99 up to 3 hours.
____________tape or disc converted to____________tape or disc __________Length of Video.
________check here for dvd-r conversion(1 hour $14.99 / 2 hour $19.99 + $5.00 conversion).
__________ Check here for run time (measure length of video if unknown) (cost 99 cents)
______________________ Country tape was made
in
______________________ Country tape is to be viewed in
*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 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 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 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