Mastering/Duplication Order Form

Fax to: 617-924-0144

Ordered by:

Name:___________________________________

Company:________________________________

Address:_________________________________

City/State/Zip Code:________________________

Ship to: (if different than ordered by)

Name:___________________________________

Company:________________________________

Address:_________________________________

City/State/Zip Code:________________________

Specifications: (Circle one for each)

Original Format: Betacam DVCam DVCPro Mini-DV SVHS VHS

Length of Video: __________

Final Format: Betacam DVCam DVCPro Mini-DV SVHS VHS

Quantity Ordered: _________

Design your label: Please print clearly

Line #1:_________________________________________________________________________

Line #2:_________________________________________________________________________

Line #3:_________________________________________________________________________

Storage Boxes and Tape Shippers (Check all that apply)

_____ Cardboard sleeve Side load w/window

_____ Black

_____ White

_____ Plastic storage box w/ 1/3 sleeve (additional $1.00 per cassette)

Foreign Tape Conversions: (Circle one)

Original Format: NTSC PAL SECAM

Final Format: NTSC PAL SECAM

Time Code Dub:

Program Time:___________

Remarks & Special Instructions:

_______________________________________________________________________________

Please read and sign

I hereby authorize Donlin Teleproduction Engineering, Ltd. to duplicate/convert the video tape as described above. I own all rights to the video(s) being sent in for duplication/conversion and will not hold Donlin Teleproduction Engineering, Ltd. liable for copyright infringement on copies ordered. I assume full responsibility for obtaining model releases when required for sale and distribution of videos. Foreign movie conversions are for my private viewing only and not for distribution or resale. I hereby agree that the handling, processing & packaging of all videos is without warranty of liability, even though defects, damage or loss by negligence or other fault may occur, furthermore, I agree to hold harmless and indemnify Donlin Teleproduction Engineering, Ltd. for any and all liability and/or claim arising from this transaction.

Authorized Signature

_____________________________________________ Date: ______________