Use this form to transfer a video tape to DVD

Foreign Video Tape to DVD Transfer Order Form

Fill out this form, Print this form out, Sign and send with your check or money order to:
High-Tech Productions 699 NW 9th Ave. Boca Raton, FL 33486
Orders will be processed and shipped within 24 hours.
* Florida residents add 6.5% sales tax to total of order. Please Print Clearly. Questions? Call 800 662-8336

Name:
Company:
Address:
City:	State:
Zip Code:
Home Phone:	Area Code:
Work Phone:	Area Code:
E-Mail:

Payment Options:
Check, Money Order, MasterCard, Visa, AmEx, Discover

Credit Card # xxxx-xxxx-xxxx-xxxx

Exp. Date: Month Year

3 or 4 Digit Bank Code on Card:

Quantity

Price Each

Total

Transfer of PAL or SECAM tape to DVD

$29.95

Additional copies 1-5=$12.00 6-10=$8.00

Shipping/handling for Disc Transfers and Copies.
1 Disc = $6.75	2 - 6 Disc's = $9.85	6 - 24 Disc's = $16.50
For higher quantities, call us toll free 800 662-8336

Sub Total

Shipping

Total

Please read and sign. I hereby authorize High-Tech Productions to transfer this video tape to a DVD. I own all rights to this video and will not hold High-Tech Productions liable for copyright infringement. I assume full responsibility for obtaining releases when required for sale and distribution. I hereby agree that the handling, processing and packaging is without warranty or liability, even though defects, damage or loss by negligence or other fault may occur, furthermore, I agree to hold harmless and indemnify High-Tech Productions for any and all liability and/or claim arising from this transaction. If I am paying by credit card, I authorize the charges for the costs associated with this order including shipping/handling and any applicable taxes. I also understand that Disc transfers are not refundable because of incompatibility.

Authorized Signature___________________________________________ Date____/____/____

Remarks & Special Instructions: