For Shipment of Tapes and DVDs to be transferred to Still Pictures by VideOccasions Please print this form, fill it in, and include with your order. Please Print Your Name ______________________________________________ Address_____________________________________________________________ City_____________________________________________State _______ Zip Code____________ Daytime Phone Number _____________________ Evening Phone Number______________________ Email address: __________________________________________ 1. Describe in detail the scenes from which you want pictures: e.g., "I'm sending you a VHS tape from which I would like to have six photo prints made. The material from which the photos are to be made is at 6 minutes seconds - the sequence in which the woman is knocked off the horse, and at 38 minutes and 30 seconds when the man in the Stetson hat walksthrough the barn door. It is important that we have a photo of the branch hitting the rider, and the moment of impact with the ground. Please be sure the man's face is not in shadow." ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ ________________________________________________________________________________ 2. I would like a total of _________ photos, __________ (number) of subject one, ___________(number) of subject two, etc. The cost of photos is $4.50 each. 3. In addition to the photos described above, I would like the .jpg files from which the photos have been made to be placed on a CD. _____Yes _____No The cost of the CD is $25.00 4. * 4x6 inch prints from video are $4.50 each. 5. * A CD with .jpg image files of the photos is $25.00 6. In addition to the charges for your photos and for a CD should you choose to have one made, you will be charged a handling fee of $3.00 and the cost of the return shipping. How you would like to handle payment for the video tape to photo transfer? Circle One: A. Include your credit card number and we will charge your account with the transfer and copy costs, shipping and handling charges.Your card will not be charged until we are ready to ship the order. Please supply: Card Type: M/C Visa (circle one) (We do not accept Debit Cards, American Express or Discover Credit Cards) Card Number: _________________________________________________ Expires (mm/yy) _________________________________ Three digit security number from reverse of card _________________ B. Have us e-mail you when the order is ready to ship and you may call us with your credit card number. DO NOT email your card number! C. Have us e-mail you when the order is ready to ship and you can send us a check. We will ship your order when your check clears. Please contact VideOccasions with any questions you may have before you send us your tapes for transfer to photo prints. VideOccasions Business Hours Monday - Friday 10:00 a.m. to 6:00 p.m., Pacific Time Zone Thursday 10:00 a.m. to 5:00 p.m., Pacific Time Zone Please remember: When it's 10:00 a.m. in New York, it's only 7:00 a.m. in Seattle. Most of our customers ship tapes to us via the U.S. Postal Service, although we also receive shipments via UPS, Fed Ex and other carriers. We suggest that regardless of the method you choose to ship your tapes you request "tracking" of the package so that both you and the carrier will know at all times the whereabouts of the package. Ship to: Contact: VideOccasions jack@videoccasions-nw.com Ê 2806 129th Ave S.E. 425-641-4811 Bellevue, WA 98005