Print and complete this form to send with your tape(s)and send to:

QUANTUM STAR, 1278 OREGON CT., CONCORD, CA 94521 USA – For further info: jd@quantumstar.com.

Please Convert To (if applicable):

PAL

NTSC

Return Shipping:	Ground	3-Day	2-Day
	Overnight	Saturday Overnight

Return Address: (we cannot ship to PO boxes)

Name or Business _________________________________________

Street ___________________________________________________

City _______________________ State _____ Zip _____________

Phone # ____________________ CELL #_______________________ Work #__________________________

Form of Payment: If you prefer to call us with your credit card details please do so. 925-890-6697
Visa	Card Number: __________________________
Mastercard	CVV^*: __________
American Express	Expiration Date: __________
Discover	* The CVV is the last 3 numbers after your account number on the back of the card, or the 4 numbers in the corner on the front of your AMEX card.

Billing Address: (if different from Return Address)

Name or Business _________________________________________

Street ___________________________________________________

City _______________________ State _____ Zip _____________

Phone # ____________________ Cell #_______________________ Work #____________________________

Personal Check	Please include check or money order with tape(s). Make check or money order payable to "Quantum Star" Call us first for total. 925-890-6697
Money Order

notes: