MEDIA VERIFICATION ORDER FORM
 To order please print and fill in this form using the command "Print" in the "File" menu.
Please send the order form and the media you want to be verified to:
DO Technical Services, Inc., 155 E. Boardwalk Dr. Suite 400 # 514, Fort Collins, CO 80525, Phone (970) 223-6036
We will contact you and let you choose the level of service you desire. There is no charge for verification with order. However, if you decide not to order, we will charge you a media verification fee* plus shipping and handling at our current rates.

 Please check the enclosed media. I would like the following services:

   Restoration_____            Conversion to_______________________________________         Duplication____

 Liability Agreement: In the event that any materials you send us are damaged, lost or not returned, you agree to accept a full refund for a blank tape, and a free processing voucher, for such materials as your sole and exclusive remedy and as the limits of our liability, and any recovery for incidental and consequential damages is excluded. It is the responsibility and liability of the customer to obtain all authorizations for copyrighted material prior to sending it to us and the customer assumes all responsibility and liability with respect to the content of any information submitted.
  Sender's info:  (please print clearly)
  Name   Signature
  Address
  City   State   Zip
  Phone  (           )   E-mail

  Comments:

. *MEDIA VERIFICATION FEES :

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