Fill In this order form, print it, and send it with your film. Use the shipping label on the bottom of this form for your convenience.
Thank You!

Integrated Imaging
1743 East 2nd Street
Casper, WY 82601
307-266-3805 ~
1-800-780-3805
www.iilabs.com

Name:  
Address:  
  
City:  
State:      Zip: 
E-mail:  
Phone:  
Ground Shipping ($10.00 - $25.00) Number of Video tapes and/or DVDs sent
3 Day Air (ground price plus $15.00) Choose Original Tape
VHS Original
Other Original
2 Day Air (ground price plus $25.00) Choose an Output Format
Recorded to VHS
Recorded to other format
Number of copies of each original        

Title for DVD Case and/or Tapes:
Next Day Air (ground price plus $45.00)
Other Instructions:












 Payment Information:
 
Card Type:      Card Number:     CVV Code:  
 Expires:  Name On Card:  
 Signature:______________________________________________________________________
Email me with a total and I'll send a check or give the card # Over the Phone
We also have a secure server for your online convenience. Check here and we will e-mail you with the total amount and you can submit payments online at: https://www.iilabs.com/pay/
shipping label Office use:
Originals
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Total __________
Format: _________________ Total __________
Duplicates   __________
Number Type Cost each Total __________
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Other fees ______________________ __________
Shipping and Handling fees: __________
Total for Transfer: __________