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Video Capture Order Form

If you have any questions about our services or need help with your order, email us.

Please print and fill out this form and fax, Toll-free, to 1-877-573-7045 or mail to:

4409 Buckley Rd.
Lisle, IL 60532

How many video tapes are you including? ____ VHS   ____ 8mm
Please have your video tape set close to the frame you would like captured. Include a brief description of the image. Describe:
What type of file would you like the image saved as?
____ .jpg ____ .bmp ____ .tif ____ .gif
What type of disk would you like your image save on?
____ 3.5" floppy ____ Zip ____ CD  
What will you be using the image for? For example: email, webpage graphic, printing, etc.
Will you be using your file on PC or Mac?
____ PC ____ Mac
Your Name:  
Your Street Address:  
Your City, St, Zip:  
Your Email Address:  
Your Phone Number:  
If you are paying by check we will email an invoice to you and your order will be shipped upon receipt of your check or money order.  If you are paying by credit card please fill out the information below. Method of Payment:
____ Check
____ Money Order
____ Visa ____ Mastercard
Card Holder Name:  
Card Number:  
Expiration Date:  

This web page and PhotoVid logo were designed by Lori Creations.
Please send any problems or comments to the
Webmaster: Tom Thornton
Date last updated: 07/24/99