WORLD VIDEO ELECTRONICS, INC.
4235 Sunbeam Rd. Jacksonville, Florida 32257
Phone: (904) 731-7474 Fax: (904) 733-8768

VIDEOTAPE REPAIR
ORDER FORM

Please complete this form, print it out, and attach with your order.

NAME:

ADDRESS:

CITY:

STATE:

ZIP:

HOME PHONE:

WORK PHONE:

E-MAIL ADDRESS:

Payment Options:

Account #

Expiration Date:

Name as it appears on my credit card for this purchase.

Signature:______________________________

Return Shipping and Handling Preference:

We will repair your original tape and return it back to you . If you need additional copies please refer to videotape duplication chart.
How many additional copies of the repaired tape should we produce for you?

How did you find us?

Terms and Conditions: I authorize the above stated work to be performed. I understand that I am responsible for any royalties which may be due, for obtaining permission to duplicate any copyrighted materials, and for the total content of the finished duplication. I do not hold World Video Electronics, Inc. liable for anything that should happen to property left, due to mechanical, technical, fire, flood, or natural disaster. If paying by credit card, I authorize the charges for the costs associated with this order including shipping and handling. Note: Florida residents will be charged 7% state sales tax.

I have read the agreement and submit my order to World Video Electronics, Inc. in accordance with the preceding terms and conditions:

Authorized signature____________________________ Date________________

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