Foreign Tape Conversion 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.

Cost of conversion:

$29.95 + $5.75 shipping & handling            Total = $35.70 per tape

$9.95 (for new customers) + $5.75 shipping & handling   Total = $15.70 per tape

* Florida residents add 6% sales tax to total of order.

Please print clearly

Name__________________________________   Phone # (               ) ____________________

Company______________________________________________________________________

Address________________________________   City____________  State____  Zip_________

If paying by credit card, type:       MasterCard           Visa         Am.Ex.         Discover

Account #______________________________________________     Exp. Date______/______

What format would you like us to convert the tape to:        PAL       NTSC         SECAM

Please read and sign.   I hereby authorize High-Tech Productions to duplicate/convert this video tape. I own all rights to the video being sent in for duplication/conversion and will not hold High-Tech Productions liable for copyright infringement. I assume full responsibility for obtaining model releases when required for sale and distribution. Foreign movie conversions are for my private viewing only and not for distribution or resale. 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.

Authorized signature___________________________________________  Date____/____/____

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