  Please print this form and include it with your order.
Media Conversion - Order Form Please include non-refundable payment of $5 per disk, tape or cartridge to cover minimum processing charges, which will be applied towards your order upon completion. If you need your media returned to you, please add return shipping. Total no. of disks, tapes and cartridges enclosed: _______________ o Call with final cost before proceeding with order o Return all materials (please specify): ¡ $9.50 Mail (no tracking) ¡ $29.50 Fedex (trackable) o Check enclosed o Credit Card #: ______________________________ Expiration: _____________ Signature: ________________________________________________________
| Name: | ___________________________________________________________________ | | Company: | ___________________________________________________________________ | | Address: | ___________________________________________________________________ | | | ___________________________________________________________________ | | | ___________________________________________________________________ | | Phone: | ______________________________ Fax:_____________________________ | | Email: | ___________________________________________________________________ |
| Mail or courier your media, along with this form, to: | Advanced Computer Innovations, Inc.
Attn: Media Conversion Services
656 Kreag Road
Pittsford, NY 14534-3730 (USA) | | 
