Video Tape Duplication Order Form
 Print this form out, fill in, sign and send with your check or money order to:
High-Tech Productions   699 NW 9th Ave.   Boca Raton, FL 33486
Orders will be processed and shipped within 24 hours.
* Florida residents add 6.5% sales tax to total of order.

Please print clearly

Name_____________________________________     Phone # (          ) _____________________

Company_________________________________________________________________________

Address____________________________     City_________________     State____     Zip______

If paying by credit card,  Account #______________________________     Exp. Date_____/_____

3 or 4 Digit Bank Code ________________         Signature_________________________________

What would you like printed on the labels? type size  type style  letter style
Line #1_______________________________________ s  M  L Block or Script Plain or Bold
Line #2_______________________________________ s  M  L Block or Script Plain or Bold
Line #3_______________________________________ s  M  L Block or Script Plain or Bold

Color of label: (Circle One)     Hi-Gloss White        Blue           Yellow           Green           Pink

Instant Art Design, Graphic or Logo_________________           Length of Video_________ min.

Quantity______   Price Each $________   Sub Total $________   S/H $_______    Total $_______

Shipping and handling is based on the total dollar amount of your order
$ .01-$50.00=$6.75     $50.01-$100.=$9.85     $100.01-250.=$16.50     $250.01-$500.=$28.75      $500. & Up=Call

Please read and sign.   I hereby authorize High-Tech Productions to duplicate this video tape. I own all rights to the video being sent in for duplication and will not hold High-Tech Productions liable for copyright infringement. I assume full responsibility for obtaining releases when required for sale and distribution. I hereby agree that the handling, processing and packaging of all videos is without warranty or liability, even though defects, damage or loss by negligence or other fault may occur, furthermore, I agree to hold harmless and indemnify High-Tech Productions for any and all liability and/or claim arising from this transaction. If I am paying by credit card, I authorize the charges for the costs associated with this order including shipping and handling. I have also read and agree to the Returns Policy.

Authorized signature___________________________       Date_____________

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