Conversion Order Form - Use this form to have a foreign DVD converted.

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, DSC

Credit Card Number: xxxx-xxxx-xxxx-xxxx

Exp. Date: Month Year

3 or 4 Digit Bank Code on Card

Cost of conversion:
$29.95 + $6.75 shipping / handling = $36.70 per DVD Total

Note: Florida residents please add 6.5% sales tax to total of order.

Please read and sign. I hereby authorize High-Tech Productions to transfer/convert this DVD. I own all rights to the DVD 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 disc's 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 have also read and agree to the Returns Policy.

Authorized Signature___________________________________________ Date____/____/____