WORLD VIDEO ELECTRONICS, INC.
3948 Sunbeam Rd. Ste. 6, Jacksonville, Florida 32257
Phone: (904) 731-7474 Fax: (904) 733-8768

VIDEO DUPLICATION
ORDER FORM

Please complete this form, print it out, and attach with your order.
NAME:
ADDRESS:
CITY:
STATE:
ZIP:
HOME PHONE:
WORK PHONE:
E-MAIL ADDRESS:
Payment Options:

Account #

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


Signature:
______________________________


Return Shipping and Handling Preference:

Please mark services requested:

Length of Video:
(Leave blank if you are not sure)

Quantity Ordered:

Check here for run time of  video:

Printed Labels:

Face Label:
Line #1

Line #2

Spine Labels:
Line #1
Line #2


How did you find us?

Terms and Conditions: I authorize the above stated work to be performed. I understand that I am responsible for any royalties which may be due, for obtaining permission to duplicate any copyrighted materials, and for the total content of the finished duplication. I do not hold World Video Electronics, Inc. liable for anything that should happen to property left, due to mechanical, technical, fire, flood, or natural disaster. If paying by credit card, I authorize the charges for the costs associated with this order including shipping and handling. Note: Florida residents will be charged 7% state sales tax.

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

Authorized signature____________________________  Date________________

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