Order Forms & IPR

1535 Filion , St.Laurent, QC H4L 4E7  CANADA

Date                              P.O.Number                                            

Selection Number                                      Order information

Disc quantity per master                Title of product                                                                                                                                

Company/Artist                                                                                                               Disac type: CD Audio (   ) CD-ROM    (    )   DVD –5   (   )     DVD-9  (  )   DVD-10  (  )

Input media Information: (   ) CD-R (   ) DLT (   ) 8MM (  ) 1630 (   ) OTHER   Premastering Required: (   ) yes (    ) no       Size of data:                                      Standard Turn time 10 to 14 days  Rush required :                                              Printed Material

CD Front booklet/folder: (  ) Additional insert (   ) Other                            Tray Card: (  ) Sticker (  ) Mailer   (  ) DVD Outerwrap/booklet           Packaging :Single Jewel box (  ) Slim line jewel box (  ) Tyveksleeve ( )5"Mailer (  ) Plastic sleeve (  ) CD-ROM Box (   ) Other (  ) Slim line double (  ) Viewpack (  ) Shrink wrap (  ) Cellophane wrap (  ) Top spine label                                   

  CD Artwork films  :Camera ready art: (  ) yes (  ) no Format: (  ) Mac (  ) PC Graphics work required                                                                                            

Colors on disc :( 1).pms#                 (2).                  (3).                 (4).              (5). White background (  ) Fonts:                                                                                Proof supplied:                                                                 

Shipping and billing information                Bill to:                                :  

 Contact Name                                            Phone #                                Fax #                                                                                                                                                

Ship To :                                                                                                                         

By signing this agreement Customer acknlowledges that he/she has read and accepts Repmedia terms and conditions. Authorized signature date;                  Federal tax Id # .                                       

order@repmedia.com