Preservation Video, Inc.
Movie Film & Video Master Order Form
INSTRUCTIONS: After printing this form, please
complete all applicable entries.
Please include the original signed form with the your
shipment. We can not begin the transfer process until we have an
original, signed form.
CONTACT INFORMATION
Name: ______________________________ Day telephone number: ____________________
Home
phone: ________________________ Email Address: ___________________________
Home
Address:
_____________________________________________________________
Mailing address
____________________________________________________________________________
City State Zip Country
Payment
Information: (circle one) Cash Check
Credit Card
Credit card
information: (the card will not be
charged unless the transfer is successful. We accept Visa and MC) This must be filled out
unless paying by check. No charges are made unless transfer is successful!
Type of
card: (circle one) Visa
MC
Name on
card: ________________________________________________________________
Card
number: __________________________ Expiration date: _____________________
Card ID
number : _______________________ What is this?
Billing
Address (for card):
_____________________________________________________________
Mailing address
____________________________________________________________________________
City State Zip Country
MEDIA INFORMATION
Place the number of rolls next to each type of media is being shipped:
8mm 50 ft roll ________
8mm roll 200 ft rolls _______
8mm 400 ft roll _______
Super 8mm 50 ft roll ________
Super 8mm roll 200 ft rolls _______ Sound: Y N
Super 8mm 400 ft roll _______ Sound: Y N
16mm 50 ft roll ________
16mm roll 200 ft rolls _______ Sound: Y N
16mm 400 ft roll _______ Sound: Y N
16mm 600 ft roll ________
16mm roll 1000 ft rolls _______ Sound: Y N
16mm 2000 ft roll _______ Sound: Y N
Place the
number of tapes next to each type of media is being shipped: VHS ____
VHS-C ____
Hi 8mm ____ Mini-DV _____
Other (please name) ________
Is this a
straight transfer? Yes ____ No _____
$30 each plus s&h
Is this an
Enhanced Transfer? Yes ____ No ____
$45 each plus s&h
Are you
requesting Authored DVD ? Yes ____ No ____
$80 each plus s&h
Any copies,
in addition to original DVD ? (1 to
10) ________ at $15 each plus
s&h
(over 10) ________ at $12 each plus s&h
Custom
editing is available at $70 per hour.
What is
your preferred return shipping carrier:
UPS _____ FedEx _____ USPS _____
For FedEx
return shipping, please include a FedEx air bill, filled out with your account
information. If not included, we will
ship via UPS or USPS.
Should we
insure the shipment: Yes _____ No _____
TERMS AND CONDITIONS
1. Authorization
The client authorizes Preservation Video, Inc.., to charge the above listed credit
card upon successful completion of digital transfer unless previous
arrangements have been authorized. All
charges, including labor, media, shipping container(s) and shipping cost will
be charged to the above card.
2. Client
Legal Rights
The client is the legal owner, representative, or otherwise has a legitimate
right to the property or act on the owners behalf.
3. Liability
Preservation Video, Inc. assumes no liability for any lost shipments or goods
damaged in Transit. All claims should be
directed to the carrier.
4. Payment
Client agrees to pay in full upon completion of services rendered by
Preservation Video, Inc.. Payment is due in full upon completion of successful
transfer and prior to release of digital images (whether shipped, picked up or
downloaded). Any other payment arrangements must be made prior to
transferring images.
5. Media
Warranty:
Preservation Video, Inc.. gives warranty on all return media (cd or dvd) found
to be Dead on Arrival (DOA) within 10 days of shipment. Any additional warranty
claims must be presented to the original manufacturer of the media.
Preservation Video, Inc. does not keep copies of your original material or
transfers.
6. Shipping:
All shipping and insurance charges are the responsibility of the
customer.
By my signature, I agree to all the terms and conditions of this contract.
Approved
By (Print name):__________________________________________
Signature:
X______________________________________________________