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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 DVDs did you have replicated last year?

Project Name:
Quantity:
Disc Type:	DVD5 (Single Layer, Single Sided 4.7G) DVD9 (Dual Layer, Single Sided 9G) DVD10 (Single Layer, Dual Sided 10G) DVD18 (Dual Layer, Dual Sided18G) Don't know
Disc Type:
Source Type:
Pre-mastering or assembly needed?:

Disc Printing:

Number of colors:	1 Color 2-Color 3-Color 4-Color 5-Color Offset (Photo Quality)
Film and proof supplied:
Properly formatted artwork supplied on WMG template:
Design required:

Packaging:

Bulk (No Packaging)	Extras:
Amray Case (Standard DVD Plastic Case)	Stickering
Jewel Case (Single DVD)	Reply Card / Other Inserts
Jewel Case (Single-width, 2 DVDs)
Jewel Case (Double-width 2-6 DVDs)
Cardboard Sleeve / Boardstock Wallet
Paper Sleeve
Tyvec Window Sleeve
Univenture Sleeve
Plastic Poly Box
Other Sleeve

Amray Case Options

Amray Cover Wrap
Shrinkwrap
Topspine Label
Insert

Paper Sleeve Options

Celophane Window?
Printed?
Flap
Special

Boardstock Wallet Options

Printed
Cardstock
Panels / Layout

Univenture Sleeve Options

Backing
Sleeve Style

Tyvec Sleeve Options

Window
Flap

Miscellaneous Packaging

Please Describe in "Notes" field below

Plastic Poly Shell Options

Color
Style

Double-Wide Jewel Case Extras

Front-of-Box Tray Card:
Colors (Front/Outside):
Colors (Back/Inside):
Quantity Needed:

Reply Card/Additional Insert

None
Provided (Insert Only)
Printing Needed

Stickering

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

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Notes (special requirements, etc.):

Indianapolis		Columbus, Ohio		Nashville		New York
800.400.4964		614.327.3744		800.874.4174		212.947.4550
Headquarters				Midsouth Service Center		East Coast Sales