Order Form for Video Tape Duplication

Video Tape Duplication Order Form

Please 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% sales tax to total of order.

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.

Color of label:	Number of Copies:
Graphic or Logo	Length of Video Minutes

What would you like printed on the labels?	Type Size	Type Style	Letter Style
Line #1
Line #2
Line #3

Shipping and handling is based on the total dollar amount of your order
$ .01-$50.00=$6.75 $50.01-$100.=$9.85 $100.01-250.=$16.50 $250.01-$500.=$28.75 $500. & Up=Call

Quantity Price Each $ Sub Total $ S/H $ Total $

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____/____/____