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Please complete the following. Items in red are required. After selecting your packaging type, please enter all information in the box related to that selection.

Business Name:
Your Name:
Phone:
Fax:
e-mail:
Your Web Site (If You Have One):

Would you like us to send you a copy of our quality sampler?

Address is required, even in not requesting a sampler.

Shipping Address:
Shipping Address (2):
City:
State:
Zip Code / Zone:
Country:

When do you expect to have the project ready for manufacturing? (if known)
Where did you hear about World Media Group?
How many CDs did you have replicated last year?

Project Name:

Quantity:

Longest Side Length:

Tape 1 : Min : Sec

Tape 2*: Min : Sec

Tape 3*: Min : Sec

Tape 4*: Min : Sec

Tape 5*: Min : Sec

Tape 6*: Min : Sec

* Multi-Tape Sets only

Tape Type:

Noise Reduction:

Source Type:

Pre-mastering or assembly needed?:

Shell Color:

If Colored, which color?:

Shell Type:

Film and Proof Supplied

Imprint (on-shell printing)

Properly-formatted Computer Artwork supplied (on WMG Template)

Design Required

Imprint Ink Color

Color

Packaging:

Bulk (no packaging)	Soft Poly	Crystal Display
Norelco Box	O-Card	U-Card
Dual Norelco	Vinyl Book	RF Blister Pack

If "Norelco Box" checked, complete these options

Shrink Wrapped
Yes No

J-Card Options
No J-card
J-Cards Supplied
Printing Required

Extra Panels?:
Number of Extra Panels:
Colors, Front:
Colors, Back:
Quantity (2500 min):

	Film and Proof Supplied
	Properly-formatted Computer Artwork supplied (on WMG Template)
	Design Required

If "O-card" checked, complete these options

Shrink Wrapped
Yes No

O-Card Options
O-Cards Supplied
Printing Required

Colors, Outside:
Quantity (2500 min):

	Film and Proof Supplied
	Properly-formatted Computer Artwork supplied (on WMG Template)
	Design Required

If "U-card" selected, complete these options:

Shrink Wrapped
Yes No

U-Card Options
U-Cards Supplied
Printing Required

Colors, Outside:
Colors, Inside:
Quantity (2500 min):

	Film and Proof Supplied
	Properly-formatted Computer Artwork supplied (on WMG Template)
	Design Required

If "Dual Norelco" selected, complete these options:

Shrink Wrapped
Yes No

J-Card Options
None
J-Cards Supplied
Printing Required

Extra Panels?:
Number of Extra Panels:
Colors, Outside:
Colors, Inside:
Quantity (2500 min):

	Film and Proof Supplied
	Properly-formatted Computer Artwork supplied (on WMG Template)
	Design Required

If "Vinyl Book" selected, complete these options:

Number of Wells:	Note: Enter extra side lengths in "Notes" below for books beyond six tapes
Color:

Slip Sheet Options
Slipsheets Supplied
Printing Required

Colors:
Quantity (2500 min):

	Film and Proof Supplied
	Properly-formatted Computer Artwork supplied (on WMG Template)
	Design Required

Additional Booklet/Literature to be included inside?

Explain:

If "RF Blister Pack " selected, complete these options:

Blister Pack Style:

(Note: if you select a package style containing a cassette inside a Norelco box, you must fill in the options above for the Norelco box option.)

Display-Card Options
Display-Cards Supplied
Printing Required

Colors, Front:
Colors, Back:
Quantity (2500 min):

	Film and Proof Supplied
	Properly-formatted Computer Artwork supplied (on WMG Template)
	Design Required

Stickering

None
Provided (apply only)
"Strong Content" Warning
Custom Design

Reply Card/Additional Insert

None
Provided (Insert Only)
Printing Needed

Notes (special requirements, etc.):

Indianapolis		Dallas		Los Angeles		Nashville		New York
800.400.4964		972.839.2054		805.300.7463		800.874.4174		212.947.4550
Headquarters		Southwest Sales		West Coast Sales		Midsouth Service Center		East Coast Sales