SHIP TO: _______________ DATE: __

Name

_____________________________ PHONE: ________________

Company

_____________________________ FAX: ___________________

Address

_____________________________ Optional ________________

City, State, Zip Code FEDEX or DHL Acct Number

RATES & FORMATS

VHS $39.95 plux tax - $42.55 – Extra VHS Copy of clip - $10.00 plus tax - $10.65

DVD: $50.00 plus tax - $53.25 – Extra DVD Copy of clip - $20.00 plus tax - $21.30

CD-ROM: $45.00 plus tax - $47.95 - Extra CD-ROM $15.00 plus tax - $16.00

CD-ROM can only be viewed on a computer.

VIEW TODAY $65.00 plus tax - $69.23. Clip will be posted to our website where you can view

and/or download the same day @ www.newsvideoservice.com/pub/

PLEASE CIRCLE OR CHECK YOUR FORMAT CHOICE & COMPLETE THE FOLLOWING INFORMATION:

Station & City:__________________________________

Day & Date of Segment:__________________________

Time of Newscast: ______________

Describe Segment:________________________________________________________

________________________________________________________

The above pricing is a per segment price. If you are ordering more than one segment, the charge is incurred for each time the newscast, station, or date changes. News Video Service archives video for 90 days from the date of airing. The clip will be exactly as it was aired by the station. Please allow 3-5 days for delivery.

If you are paying by check, please make checks payable to NEWS VIDEO SERVICE and mail to the above address.

It is understood that the copyright ownership remains with the station. The video is provided for personal use only and cannot be reproduced, used for rebroadcast, resale or any commercial use without express written consent of the TV station.

CREDIT CARD PAYMENT AUTHORIZATION

I hereby authorized News Video Service to charge my credit card in the amount of $______________ for above video clip(s). Florida Sales Tax Exempt Organizations, please attach a copy of your tax-exempt certificate.

CARD NUMBER: ________________________________________ EXPIRATION DATE____________________

AUTHORIZED SIGNATURE: _____________________________________________________________________

Print Name as it appears on card __________________________________________________________________

Thank you for using News Video Service.

SHIP TO: _____________________________ DATE: _______________­­_