Foreign Tape Conversion Order Form

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

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

Credit Card Number: xxxx-xxxx-xxxx-xxxx

Expiration Date: Month Year

Name as it appears on the credit card.

Indicate Format to convert to: PAL NTSC SECAM

Cost of conversion:
$29.95 + $5.75 shipping / handling = $35.70 per tape Total

$9.95 (for new customers) + $5.75 s/h = $15.70 per tape Total

Note: Florida residents please add 6% sales tax to total of order.

Please read and sign. I hereby authorize High-Tech Productions to duplicate/convert this video tape. I own all rights to the video being sent in for duplication/conversion and will not hold High-Tech Productions liable for copyright infringement. I assume full responsibility for obtaining model releases when required for sale and distribution. Foreign movie conversions are for my private viewing only and not for distribution or resale. I hereby agree that the handling, processing and packaging of all videos 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.

Authorized Signature___________________________________________ Date____/____/____