Please complete this order form, print, and send with your
Credit Card information, Check, or Money Order to:
CHANNELL VIDEO PRODUCTIONS
563 North 355 West
Orem, Utah 84057





Quantity: DVD Disc Duplication Order Form
If you need help filling out the order form call 1-800-405-4809
50 Disc's Minimum Order
Enter the number of Disc's to be duplicated $2.75 per disc
Inkjet Printing on the DVD Disc
$.75 per disc
Jewel or Clear Clam Shell Case
.45¢ per case
Text Title Printed on the DVD Disc
Return Shipping & Handling "Required"
(Enter the number of Disc's to be duplicated)

"Click Here" for TOTAL




Name:
Address:
City:
State:
Zip Code:
Phone:
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Payment Options: Card Type:
Card Number:
Expiration Date: Month Year: Month

" The CVV2 number is a fraud-prevention measures implemented by VISA and MasterCard.
The 3 digit number is printed (not imprinted) on the back of the card,
just after the credit card number."
CVV2:
I agree to pay the total amount according to the card issuer agreement.

Cardholder's Signature:__________________________________ Date:_____________

If paying by check or money order, make payable to CHANNELL VIDEO PRODUCTIONS
Only checks drawn on US Banks or domestic money orders in US $ will be accepted.
For your protection you should insure or register any items that are valuable or irreplaceable.
Channell Video Productions is not liable for any loss, damage,
or delay to provided material during the duplication process or while in transit.
Be sure to have a back up copy of your DVD production.
To the best of my knowledge, the video material I am submitting to Channell Video Productions
for duplication is not protected by copyright or owned by another.
Channell Video Productions will not transfer any offensive or pornographic video material.