Print and complete this form to send with your tape(s) or DISCS to:

Quantum Star
1278 Oregon Ct.
Concord, CA 94521
Tel. (925)686-9945

Please Convert To (CIRCLE if applicable): DVD PAL (outside the USA) DVD NTSC (for the USA and other NTSC countries) (DVD discs are ONLY PAL or NTSC worldwide)

or

Convert to VHS VIDEO TAPE (Circle the video standard you want the copy to be in):

PAL NTSC PAL-M (Brazil) PAL-N SECAM

Circle Return Shipping Desired:

Ground (Cheapest, 3-7 days) 3-Day 2-Day Overnight Saturday Overnight

Return Address:

Name or Person and/or Business _________________________________________

Street ___________________________________________________ City ____________ State _____

Zip _____________ Phone # ____________________ CELL #_______________________

Work #___________________ EMAIL ADDRESS for your receipt _________________________________________

Form of Payment: If you prefer to call us with your credit card details please do so. 925-890-6697

Visa Mastercard American Express Discover

Card Number: __________-______________-________________-____________________

CVV*:___ __________ Expiration Date: MONTH __________YEAR____________

* The CVV is the last 3 numbers after your account number on the back of the

card, or the 4 numbers in the corner on the front of your AMEX card.

Billing Address for CREDIT CARDS only (if different from Return Address)

Name or Business _________________________________________________

Street ___________________________________________________________

City _______________________ State ________________ Zip _____________

Phone # ____________________ Cell #_______________________

Work #____________________________

Personal Check or Money Order

Please include check or money order with tape(s). Make check or money order

payable to "Quantum Star" Call us first for total. 925-890-6697

Thank you, John Dulaney QUANTUMSTAR

Quantum Star-International Video
546 Crossen Ave
Elk Grove IL 60007
Tel. (847) 640-9000