Preservation Video, Inc.
Slides/negative/ASP 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 scanning until we have a signed,
original form.
CONTACT INFORMATION
Name: ______________________________ Day telephone number: ____________________
Tile: ________________________________ Fax number:
____________________________
Company: ___________________________ Email Address: ___________________________
Company
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 scanning is successful. We accept Visa and MC) This must be filled out unless paying by cash/check. No charges are
made unless scanning is successful!
Type of
card: (circle one) Visa
MC
Name on
card:
________________________________________________________________
Card
number: __________________________ Expiration date: _____________________
Card ID
number : _______________________ What is this?
MEDIA INFORMATION
Place the
number of images next to each type of media is being shipped: 35 mm slides ____
35 mm
negatives ____ ASP ____
Other ____
At this time,
we regret that we can not accept extra thick mounts or glass encased mounts.
What is the
original film type, if known:
Kodachrome _____ Ektachrome
_____Other _____
Image
format requested: TIFF (recommended)
_____ JPG _____ Both _____
Scanning
resolution requested: 1200 _____ 2000
_____ 3200 _____
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 scanning. All charges, including labor, media, shipping
container(s) and shipping cost will be charged to the above card.
2. Client Legal Rights
It is the client’s responsibility to ensure that you are in compliance with copyright law. By signing this order agreement you are confirming to us that you are authorized to use all photographs, film, videos and musical works to be used in the creation of your DVD. Shoebox Memories is not responsible for verifying this information, and is hereby released of the liability. We reserve the right to refuse orders, at our discretion, that include questionable content.
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
scanning and prior to release of digital images (whether shipped, picked up or
downloaded). Other payment arrangements should be made prior to
scanning.
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. will keep a copy of scanned images for 10 days to insure against
DOA instances. After 10 days, we destroy all copies of your images.
6. Shipping:
All shipping and insurance charges are the responsibility of the
customer.
7. Estimates:
Client will be contacted via phone or email with a price quote prior to
any work being performed. Once said
client agrees to the pricing, work will begin.
By my signature, I agree to all the terms and conditions of this contract.
Approved
By (Print name):__________________________________________
Signature:
X______________________________________________________