EverMedia
Multi-media Services
Video to VHS
Order Form
(Valid until end May 2008)

Please print, complete and send this form together with your payment and video tapes to:
EverMedia Ltd, A3, Moor Lane Business Centre, Moor Lane, Widnes, Cheshire, WA8 7AQ, England, UK

Name & Address
EverMedia does not disclose your information to any third-parties.

Name		Official Use Only:
Company
Address
Post Code
Telephone (Day)
Telephone (Evening)
Email
Date Conversion(s) Required by
Please help us serve you better by filling our quick survey below. Thank You
How did you learn about our service?	[  ] Internet Search Engine _______________ [ ] Newspaper Reviews _________________ [  ] Recommended By ___________________ [  ] Returning Customer [  ] Other _____________________________
How do you rate our web site?	[ ] Informative [ ] Easy to use [ ] Tidy [ ] Needs more information [ ] Not easy to use [ ] Untidy Other Comments:
What attracted you to use EverMedia?

Please include titles for each tape along with any special instructions (or attach separate sheet).

Order Items
Description	Qty	Unit Price	Total
Up to 2 hours of Video to VHS	__	£16.50	£______
Up to 3 hours of Video to VHS	__	£17.50	£______
Up to 4 hours of Video to VHS	__	£19.50	£______
Tape Surcharges (No Surcharges for PAL: VHS, VHS-C, Betamax, MiniDV, Video 8, Hi8, Digital 8, SVHS tapes) For DVCam, Betacam SP or U-Matic Add £9.00 per For MicroMV add £3.50 For NTSC: MiniDV, Hi8, Video 8 Add £4.00 per source or maximum of £20.00 for more than 5 sources.	__	£____	£______
TV System Conversion Options: [ ] NTSC to PAL Conversion [ ] PAL to NTSC Conversion	__	Free	Free
Additional VHS Copies Up to 2 hours @ £6.50 each, Up to 3 hours @ £7.50 each For quantities over 5 please contact us for discounts	__	£____	£______
Rush Job Surcharge (per tape) 3 Days @ +10%, 2 Day @ +20%, 1 Day @ +30%, Same-Day @ +40% - Subject to availability – Please check prior to placing order	__	£____	£______
Other Options:
Risk Free Delivery Service Approximately £5.00 for first tape + £1.00 per additional tape Please call for pricing or exclude and we will bill on delivery.			£______
Total Order			£______

Order Confirmation

I have read, understood and agree with the terms and conditions of service (as published at www.EverMedia.co.uk).

Please Tick one:
[ ] I am enclosing a cheque/postal order for £_______ made payable to "EverMedia".
[ ] I would like to pay by Credit Card online using PayPal secure payment system. I understand this is subject to 4% surcharge. Please send PayPal invoice to my email address.
[ ] Inform me of the final costs and I will send full payment within 48 hours of notification.
[ ] Invoice my company [ ] by email to _______________________ (email address)
(Terms: 7 days) Our Order Reference __________________________

I accept full responsibility for the content of my original videos being copied or converted to the requested media. 

Signature _______________________________ Date __________________