VIDEOTRANSFER.COM Film Transfer ORDER FORM
Please print this form and enclose it with your order

1. Please complete form, print it out and return it with your order:

NAME:
ADDRESS:
CITY: STATE:
ZIP:
HOME PHONE:
WORK
PHONE:
E-MAIL ADDRESS:

2. Check all that apply. Please transfer film to:

DVD
USB Computer file .MP4
Other:__________________________________

3. Return Shipping Preference:


4. If transfer is to DVD, how many total sets should we produce for you?

Remarks:
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
__________________________________
 5. Payment Options:


Credit Card Number:

Expiration Date (MMYY):

Card Security Code: 

Name as it appears on my credit card for this purchase.

Address associated with credit card.

______________________________________________

_____________________________
6. Opening Title-choose one

Precious Memories of the            Family
Family Memories
Family Memories
Other - PLEASE PRINT CLEARLY on back of form.

7. Closing Title - choose one

Thanks for the Memories!
Other - PLEASE PRINT CLEARLY.

_____________________________________________________

8. Please print and mail to:

VideoComm Technologies
361 East Parkwood Ave
Friendswood, TX 77546

Questions? Please e-mail us at or call

toll free at 888/778-4336

Terms and Conditions: When submitting any media to us, client acknowledges and agrees that 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 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. from any costs related to copyright infringement. Shipping and handling charges will be added to your order.  Note: Texas residents will be charged 7.75% state sales tax.
I have read the agreement and submit my order to VTI, Inc. in accordance with the preceding terms and conditions:

9. X__________________________________________________________Date_________________________