Integrated Imaging Film to Video and DVD Order Form

Film to DVD or Video Order Form

Fill In this order form, print it, and send it with your film. Use the shipping label on the bottom of this form for your convenience.
Thank You!

Integrated Imaging
1743 East 2nd Street
Casper, WY 82601
307-266-3805 ~
1-800-780-3805
www.iilabs.com

Name:

Address:

City:

State:

Zip:

E-mail:

Phone:

Ground Shipping ($10.00 - $25.00)

Number of Video tapes and/or DVDs sent

3 Day Air (ground price plus $15.00)

Choose Original Tape
VHS Original
Other Original

2 Day Air (ground price plus $25.00)

Choose an Output Format
Recorded to VHS
Recorded to other format
Number of copies of each original

Title for DVD Case and/or Tapes:

Next Day Air (ground price plus $45.00)

Other Instructions:

Payment Information:
Card Type: Card Number: CVV Code:

Expires:

Name On Card:

Signature:______________________________________________________________________

Email me with a total and I'll send a check or give the card # Over the Phone
We also have a secure server for your online convenience. Check here and we will e-mail you with the total amount and you can submit payments online at: https://www.iilabs.com/pay/

Office use:

Originals	_________________		Total	__________
Format:	_________________		Total	__________
Duplicates				__________
Number	Type	Cost each	Total	__________
_______	____	___________	Total	__________
_______	____	___________	Total	__________
Other fees	______________________			__________
Shipping and Handling fees:				__________
Total for Transfer:				__________