DVD Duplication Order Form

DVD 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
* Florida residents add 6.5% sales tax to total of order. Please Print Clearly. Questions? Call 800 662-8336

Name:
Company:
Address:
City:	State:
Zip Code:
Home Phone:	Area Code:
Work Phone:	Area Code:
E-Mail:

Payment Options:
Check, Money Order, MasterCard, Visa, AmEx, Discover

Credit Card Number: xxxx-xxxx-xxxx-xxxx

Exp. Date: Month Year

3 or 4 Digit Bank CID Code (on Card)

Choose Graphic or Logo or Background Image

What would you like printed on the Disc's?	Type Size	Type Style
Line #1
Line #2
Line #3

Price Each

Total

Number of Copies Needed?

Select Type of Packaging

If you are using your own art work, 1 time set-up fee

$25.00

Shipping/handling for Disc Duplication.
1 - 5 Disc's = $6.75	251 - 500 Disc's = $40.25
6 - 25 Disc's = $9.85	501 - 1000 Disc's = $59.90
26 - 100 Disc's = $16.50	1001 - 2500 Disc's = $84.75
101 - 250 Disc's = $28.75	2501 & up = Call us for rate.

Sub Total

Shipping

Total

Please read and sign. I hereby authorize High-Tech Productions to duplicate this DVD disc. I own all rights to this disc 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 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. I also understand that Disc transfers are not refundable because of incompatibility. I have also read and agree to all of High-Tech Productions Policies. If I am paying by credit card, I authorize the charges for the costs associated with this order including shipping/handling and any applicable taxes.

Authorized Signature___________________________________________ Date____/____/____

Remarks & Special Instructions: