International Video Conversions
7398 10^th Street North
St. Petersburg, FL 33702-5102
(727) 526-8729
VIDEOCONVERSION.NET

Please sign and date the following declaration: 
I declare that the media as noted below:

__________________________________________________________

__________________________________________________________

 __________________________________________________________  

is my own personal property and is converted to/from the NTSC Standard for my own personal use only.
The converted video(s) will not be copied or distributed and the conversion(s) will be retained along with the original media. 

Please sign and include this form with your video to expedite service.

Signature:           _______________________________

E-Mail Address: _______________________________

Phone #:             _(____)_______-_________________

Date:                   _______________________________

  
Thanks once again,
             International Video Conversions

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            Internal Use Only 

    Invoice #:___________

    Date:      ___________
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http://www.videoconversion.net/index.html