DVD Transfer Service, Inc. Order Form

INSTRUCTIONS:
1. Print and complete this Order Form.
2. Contact us by e-mail to confirm an appointment for your DVD Transfer
3. Mail Order Form, videos, and payment to:
DVD Transfer Service, Inc., 128 Park Ave., Humboldt, NE 68376

We recommend that all orders be insured and delivery confirmation is purchased, especially when sending us your videos

CUSTOMER INFORMATION

NAME
ADDRESS
CITY
STATE		ZIP
E-MAIL		PHONE
ADDITIONAL COMMENTS

ITEM	QTY	TOTAL
DVD-Video Transfers (see price list for rates)
DVD-RAM Transfers (2 hours) ($35.00)
DVD-RAM Transfers (4 hours) ($50.00)
VHS Transfers ($10.00)
DVD Label (text only) ($2.00)
DVD Label (w/picture) ($3.00)
Jewel Case Label (text only) ($3.00)
Jewel Case Label (w/picture) ($4.00)
DVD & Jewel Case Labels (text only) ($4.00)
DVD & Jewel Case Labels (w/pictures) ($6.00)
SHIPPING Media Mail (see price list for rates) Priority Mail (add $5.00 to Media Mail rate) Delivery Confirmation ($.70 for Media Mail or $.40 for Priority mail)
SubTotal:

Total:

PAYMENT: Please send Payment payable to: DVD Transfer Service, Inc.

Send Order to:

DVD Transfer Service, Inc.
128 Park Ave.
Humboldt, NE 68376

Please allow 7-14 business days from arrival of your package.
Thank you for your business.

Preserve All Of Your Precious Videos On DVD!!!