Please mail all orders to
International Video
620 Bennett Rd
Elk Grove IL 60007

Please fill out the form below and print it. You can then send it along with your video(s).  If you have more than one video, please just write a note on the back of the form with order details for each video. You don't need to fill out a seperate form for each video, but please make sure that you clearly indicate what you would like us to do with each video.

Shipping Information:

 Name:

Address:

City:

State/Province:

Zip/Postal:

Country:

Email:

Home Phone:

Work Phone:

Cell Phone:

Standard Conversion price ($10.00)

Original Tape Information             

My original tape is:        

I would like my cassette converted so I can play my new cassette in:
NTSC (United States)  |   Pal  |   Secam          Country :


TAPE LENGTH

My orignal tape length is:   Total tape length must be 2 hours or less.

Title Printed on cassette label and attached to cassette  $ 5.00 (If desired, please type in title)
  

A regular cardboard sleeve comes with at no charge, upgrade to a plastic protective case is extra.
Protective Plastic VHS Case  $3.00 (Check box to add) 

Number of Extra VHS copies:  @ $8.00 Each

Number of DVD copies:     @ $19.00 each

If you would like a dvd copy, please fill out the dvd form instead

USA Shipping: UPS Ground ($7.00) UPS 3 Days Select ($15.00) UPS 2nd Day ($21.00)  UPS Next Day Air ($29.00)

Payment:

Please add up total price of order:  $

If sending a check, please make it payable to international video and  include it with your order. If paying by credit card, please fill in the information below.

Name on card:     Credit card #:   Exp Date: