SHIP PROJECT MATERIALS TO: Dave Seltzer, Producer 549 Acorn Dr. Dayton, OH 45419 SAMPLE ORDER FORM 2014 CUSTOMER NAME: STREET ADDRESS: CITY, STATE: DAYTIME PHONE: ( E-MAIL ADDRESS: ) Questions? Call Toll-Free: 1-866-383-2523 DATE: APT #: ZIP: ALTERNATE PHONE: ( ) DESIRED COMPLETION DATE: PROJECT TITLE: NOTE: The title, such as “Smith Family Movies” appears on DVD surface and opening screen. SAMPLE FEE for one 3-inch (50-ft) reel Please enclose cash, check, or money order. $6.00 This is a promotional price that covers cleaning your film, transferring to a DVD that is imprinted with your project title, and return shipping. You will receive an e-mail when your reel is received, and most samples are processed in 2-3 days. Your original reel and the DVD will be returned by First Class Mail. COPYRIGHT AND LIABILITY AGREEMENT The undersigned agrees that the film,video, photographs, and music sent to Seltzer Productions (Best Film Transfer) are not copyrighted or owned by someone else, or that written permission for duplication has been obtained from the copyright owner. The undersigned agrees that this order is exclusively for private use and will not be commercially distributed. The undersigned agrees that Seltzer Productions will not be liable for damages or delay to the materials sent for duplication or transfer. Liability will be limited to the replacement cost of unexposed film or tape. Seltzer Productions guarantees the transfer of film or video to DVD. Seltzer Productions does not guarantee that the DVD will work in every player. The undersigned agrees that no refunds will be given. Customer Name (print)___________________________________________ Customer Signature _____________________________________________ Date_______________