***Please print out this page, fill in completely and ship with the video tape to be converted.

Name ________________________________________

Address ______________________________________ City ___________________

State_________________ Zip Code _______________

Day Phone ____________________________________

Night Phone ___________________________________

E-mail ________________________________________

Please check one of the following:
___ less than 30 minutes ___ 31 to 60 minutes ___ 61 to 90 minutes ___ 91 to 120 minutes

Chapter Points
Using time code or the time counter of your tape deck indicate the time in the program where the chapter points should be placed
(1) _______ (2) _______ (3) ________ (4) ________ (5) _________
(6) _______ (7) _______ (8) ________ (9) ________ (10) ________

Case options: (no additional charge) _____Jewel Case (CD type) _______ DVD Box

Please indicate the actual title to be printed on the Disk:
Title_________________________________________________________________

Please indicate the actual title to be shown on the screen when disk starts:
Check here ____ if using same as printed title.

Title________________________________________________________________

The inital start-up screen can be your graphic if supplied on disk (floppy or Zip or CD)
Formats - accepted: BMP, Targa, Tiff, Jpeg.

Please indicate the name of the file to be used ________________________________

Payment info:
_____Visa ______Mastercard No. _________________________________________________

Expiration Date ____________________

**Shipping **
Orders are usually completed within 3 to 5 days to the address listed above using UPS.
Standard shipping charge is $5.00

All Occasion Video Productions
1250 Southampton Road
Phila. Pa. 19116