Please fill out the name and address of where to ship your selection(s).
We can not ship to PO boxes.  Actual street addresses only.
NAME___________________________________________________________
ADDRESS________________________________________________________
ADDRESS________________________________________________________
CITY_________________________ STATE______ ZIP___________________
COUNTRY (if arranged previously via email)____________________________
CONTACT EMAIL_________________________________________________

QTY     ITEM

______    BOX OF FILM-TECH MEDIA PADS (110 CORES/each)
______    FILMGUARD CLEANER KIT (150 CORES/each)

*******DOUBLE CHECK THE QUANTITY OF CORES BEFORE YOU SHIP!!!*******

Ship cores to be recycled to:
Film-Tech Cinema Systems
ATTN:  Recycling Program
3033 Kellway Drive, Suite 128
Carrollton, TX 75006

*You MUST include this completed form with your cores.
*Please allow a full 30 days for items to arrive.
*If your email includes the letters "L", "I", "O" or the numbers "1" or "0" you need to make certain
that you distinguish this so there is no confusion should we need to contact you if there is a problem
with your order.
*The current deadline for receipt of cores in this recycling program is 6-31-04.  This offer may be
extended in the future depending on popularity and will be noted on the Film-Tech website.
*We are not responsible if you return an incorrect amount of cores.  Shortages will be refused
redemption of the above items and overages will not be credited.  Please prevent this from
happening and triple check your count before you ship.
*Requirements and offers may change from time to time.  Please make certain you have the latest
version of this order form from the www.film-tech.com website.  (Click on "FilmGuard")  Orders
received more than 14 days after this form has been modified may be rejected if what you are
requesting is no longer applicable.  The date of this form's most recent update is at the top of the page.