ICTV1 NEWS VIDEO SERVICE...............REQUEST FOR VIDEO FORM
ICTV1, P. O. BOX 725, Palm Beach, Florida 33480 Att: Neil London 954-296-5204
VIDEO CLIP DUBS ARE PRICED FOR 1 - 30-MINUTE CLIPS MAXIMUN LENGTH - CALL FOR OTHER PRICING

REQUEST FOR VIDEO
(Written Transcripts Are Not Available)

SEND TO:_______________________________________DATE: __________________________
(Name)
________________________________________________PHONE:_________________________
(Company, if applicable)
________________________________________________
(Address)
________________________________________________EMAIL:__________________________
(City, State & Zip Code)

Event Name / Location:____________________________________________________________

Day & Date of Segment:___________________________________________________________

Time of Newscast:________________________________________________________________

Describe Segment: _______________________________________________________________


I would like to order a DVD copy of the above ICTV1 video if available.

Mail your completed order form to us with payment of $100.00. Please allow 10 to 14 days for delivery.

PAYABLE TO: ICTV1
MAIL TO: ICTV1 / NEIL LONDON
P. O. BOC 725

Palm Beach, FL 33480

TERMS : It is understood that all copyrights, proprietary interests and other incidents of ownership in and to the
videotaped material shall remain vested with ICTV1. Any exception to the foregoing shall be permitted only with

the express written consent of the ICTV1. It is further understood that this video is for my personal use only, will
not be reproduced, or used for rebroadcast, resale, commercial use or any litigation involving ICTV1 or any
ICTV1 production coverage venue, ICTV1 associate, event or product promoter, performer or affiliate of ICTV1.

SIGNATURE: ______________________________PRINT NAME: __________________________

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