Video Doc Productions 5833 Library Road Bethel Park, PA 15102 412-835-0643
ALL LINES MUST BE FILLED OUT COMPLETELY PLEASE P R I N T CLEARLY
Customer Name:_________________________________________________________________
Mailing Address: (No P.O. Boxes): _____________________________________________________
City: _______________________________________ State: __________________
Zipcode: ______________
Daytime Phone Number With Are Code: _______________________________
Number of Reels Supplied: ______________
Total Number of Copies (Including the master DVD): ________________
ARE REELS NUMBERED AND IN ANY PARTICULAR ORDER: YES______ NO ______ RANDOM ______
WOULD YOU LIKE US TO ADD EASY-LISTENING INSTRUMENTAL BACKGROUND MUSIC?
YES ______ NO _____
TITLE TO BE ADDED AT THE BEGINNING OF THE VIDEO: _______________________________________
(Example: Rudolph Home Movies 1965 - 1978)
Any Special Instructions: __________________________________________________________________
______________________________________________________________________________________
NOTE: UPS WILL NOT SHIP TO POST OFFICE BOXES.
Checks will be accepted. Orders will ship when check clears. Shipping charges are additional.
I authorize Video Doc Productions to complete the work submitted for the above mentioned transfer.
__________________________________________________________________________________
Sign, Print Name and Date
YOU MAY PAY BY CREDIT CARD BY CALLING OUR OFFICE AT 412-835-0643