Video Dub Request

You must BOTH submit the form and THEN pay using PayPal. A PayPal account is NOT required, credit card payments are accepted.

1.Contact Information

Today's Date*

First Name*

Last Name*

Street Address*

City*

State*

Zip*

Home Telephone*

Email Address*

2.Video Request

Date Story Aired

Number of Copies Requested

3.Story Appeared on News:*

6am	Noon	5pm	6pm	10pm


Other (please specify)

4.Please describe video*

5.KWTX-TV keeps newscasts on file for a limited period of time. No guarantee is implied the requested material is still on file.

KWTX-TV reserves the right to refuse any request.

Requests for copies of any material for use in litigation will require a subpoena.

Copies of any material for re-broadcast or re-transmission electronically is not permitted.

Only material that aired is available. Material not broadcast is not available.

Copies provided by KWTX-TV under this agreement are intended for private home use and may not be duplicated, re-broadcast or transmitted electronically. All material copied remains covered by copyright laws protecting KWTX-TV.

Please allow two weeks for completion and mailing. All copies will be mailed to the address listed on this form.

All dubs are on DVD.

If the request cannot be completed, payment will be refunded through PayPal.

Yes, I have read, understand, and agree to the above policies, Web site usage agreement and privacy policy.*

	Yes, I agree

	No, I do not agree

6.Date of Birth (Must be 13 years or older to enter this form)

Month*		Day*		Year*

* represents required fields

Video Dub Request

Product Description		Price	Add to Cart
	Video Dub Request DVD sent via mail	$45.00