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On-line Order Form

Please provide the following information:

First Name
Last Name
Company Name
Street Address
Address (cont.)
City
State/Province
Zip/Postal Code
Country
Phone
FAX
E-mail

Please provide the following story details:

City:
Station(s):
Local  or  National:
Video Format:
Number of Copies:
Date of Story:
Time of Newscast:
Story Description: Please be as detailed as possible

BILLING
Credit Card
Cardholder Name
Card Number
Expiration Date

I authorize News Video Service to charge my credit card in the amount  of $ for news video clip(s), plus tax if applicable. 

For Florida Sales Exempt Organizations only, please enter your Sales Tax Certificate Number. 

If you would prefer expedited shipment, please provide a FEDEX or Airborne number: .

Submitting this request for video will also serve as your acknowledgement that the copyright is held by the station, and as such, is protected by all copyright laws.

Thank you for using News Video Service!

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