Integrated Imaging Video to DVD Order Form

Video Tape To DVD Order Form

Fill In this order form, print it, and send it with your order. Use the shipping labels on the bottom of this form for your convenience.
Thank You!

Integrated Imaging
1743 East 2nd Street
Casper, WY 82601
307-266-3805 ~ 1-800-780-3805
www.iilabs.com

Name:

Address:

City:

State:

Zip:

Ground Shipping ($10.00 - $25.00)

E-mail:

3 Day Air (add $15.00 to ground price)

Phone:

2 Day Air (add $25.00 to ground price)

Number of tapes sent

Next Day Air (add $45.00 to ground price)

Choose DVD Option (price each)

Other Instructions:

Mastered DVD $150.00 1 hour mode (highest quality)

Mastered DVD $150.00 2 hour mode

Recorded DVD $29.95 1 hour mode (highest quality)

Recorded DVD $29.95 2 hour mode

Title for DVD case:

Additional VHS copies of each DVD $19.95 Each

Additional DVD copies of each DVD $14.95 Each

Payment Information:
Card Type: Card Number: CVV Code:

Expires:

Name On Card:

Signature:______________________________________________________________________

Email me with a total and I'll send a check or give the card # Over the Phone
We also have a secure server for your online convenience. Check here and we will e-mail you with the total amount and you can submit payments online at: https://www.iilabs.com/pay/

Office use:

Originals	_________________		Total	__________
Format:	_________________		Total	__________
Duplicates				__________
Number	Type	Cost each	Total	__________
_______	____	___________	Total	__________
_______	____	___________	Total	__________
Other fees	______________________			__________
Shipping and Handling fees:				__________
Total for Transfer:				__________