“Discover Your Library” PSA Order Form
Name: _________________________________________________ Date: ___________________________________
Library/Organization Name: _______________________________________________________________________________
Phone: _____________________________________ E-Mail: _________________________________________
Ship To: please note shipments cannot be delivered to a PO Box
Name:
Address:
City: State: Zip:
All orderS muST be prepAid before proceSSing. pleASe Send ThiS form wiTh check To:
Jennifer Pavlik
Douglas County Libraries
100 South Wilcox
Castle Rock, CO 80104
pleASe mAke checkS pAyAble To: douglAS counTy librArieS foundATion
or fAx ThiS form wiTh crediT cArd number To: 303-688-7655
q Visa q Master Card q American Express q Discover
CC#: ______________________________ Expiration Date: ____/____ (MM/YY)
Cardholder Name:________________________ Signature Of Cardholder: ________________________
Prices below include the cost of dubbing and shipping via UPS ground. Allow 2-4 weeks for delivery.
• opTion 1: Beta SP or DVCam with 2 generic Beta SP DVCam
PSAs (30 sec. & 60 sec.): $95.00 Quantity: _______ x $95.00 q q
• opTion 2: Beta SP or DVCam with
2 Customized PSAs (30 sec. & 60 sec.): $145.00
includes website and/or Library name Quantity: _______ x $145.00 q q
Total: $__________
inSTrucTionS for cuSTomizATion:
Library’s name or website can be added to the beginning and/or end of the PSA.
Name or Website at beginning: _____________________________________________________________________
Name or Website at end: __________________________________________________________________________
For billing questions or questions about customizing the PSAs for your library,
please write to Jennifer Pavlik at jpavlik@dclibraries.org
DouglasCountyLibraries.org CO/JP308