Video Tape-to-DVD Transfer Order Form

Print this form out, fill in and send with your tape and payment option to:
Creative Graphics.. .627 Courtney Lane ...Marengo, IL 60152
Orders will be processed and shipped within 72 hours.
Please print clearly! ....Questions? Call 815-568-3841 or e-mail
First Name:
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Payment Options

We accept checks, money orders, Visa, MasterCard, Amex, Discover, or we can send you an invoice to a valid e-mail address which will allow you to pay using the PayPal invoicing system. There is no extra charge for using the PayPal system, however a valid e-mail address is required!
Last Name:
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Address:
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City:
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State:
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Zip Code:
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Phone:
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...My check/mo is enclosed
E-Mail:
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...YES! I'll pay using PayPal
Credit Card #:
Credit Card Expiration:
Credit Card Security Code (usually on the back, next to signature line, 3-4 digits):
Disk Imprinting Option
What would you like us to print on the label side of the DVD
< click here to see examples >
Text for Main Title Line #1:
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Text for Subtitle Line #2:
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Text for Text Area #3:
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Background Color - Circle One:.....Red.....Green.....Blue....
Packaging Preference (click here to view options):
Tape-to-Disk Transfer: $9.95
Additional copies of DVD: (# of copies______ X $2.95 for each additional copy) $
Shipping ($4.95 for 1-3 disks / $7.95 for 4-10 disks / $9.95 for 11-20 disks) $
TOTAL FOR THIS ORDER... $
Please read and sign.  I hereby authorize Creative Graphics to transfer this video tape to disc. I own all rights to this video and will not hold Creative Graphics 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 Creative Graphics for any and all liability and/or claim arising from this transaction. If I am paying by credit card/PayPal, I authorize the charges for the costs associated with this order including shipping/handling. I also understand that Disk transfers are not refundable because of incompatibility.

Authorized Signature__________________________________  Date____/____/____

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