Please print this form and enclose it with your order.

1. Complete this form, print & return it with your order:


2. Return Shipping Preference:

3. We will repair your original tape and return it to you along with a DVD.  Extra DVD copies are also available.  How  many total DVD copies should we produce for you? Please indicate below.


4. Payment Options:

Credit Card Number:

Expiration Date:     

Card Security Code: 
Name as it appears on my credit card for this purchase.

5. How did you find us?

If 'search engine', which one?


6. Please print and send completed form along with your order to: 

VideoComm Technologies International, Inc.
361 East Parkwood Ave
Friendswood, TX 77546

Questions? Please email us at  or call


or toll free at 888-778-4336

Terms and Conditions: When submitting videotapes, films, slides or any other media to us whether for duplication, conversion, repair, video transfer or for any other reason, client acknowledges and agrees that VTI, Inc. and any individual or business affiliated with VTI, Inc. shall not be liable for any loss or damage to such materials following receipt and during processing of such materials (even if due to our fault or negligence) and that the client’s sole remedy shall be replacement with a similar amount of blank video tape. VTI, Inc. makes no other warranty and assumes no other risk and shall not be liable for any indirect special, incidental or consequential damages resulting from client’s use of our services. This agreement excludes specifically any counteroffers by client including (without limitation) statements of value in excess of replacement cost of a similar amount of videotape or requests for special handling. Client warrants that the videotape, film, photos, slides or other media submitted to VTI, Inc. for processing is not protected by a third party copyright owner or if protected, the client has obtained permission of such third party copyright holder to make copies. Client also agrees to protect and indemnify VTI, Inc. (or it's assignees) from any costs related to copyright infringement. Shipping and handling charges will be added to your order. Note: Texas residents will be charged  state sales tax.

I have read the agreement and submit my order to VTI, Inc. in accordance with the preceding terms and conditions:

7. X_____________________________________________________________Date______________________

Please print this form and enclose it with your order.