This document is an order form for "Discover Your Library" public service announcements (PSAs). It requests the customer's contact information and shipping address. Payment must be prepaid by check or credit card before orders will be processed. The form offers two options - generic PSAs for $95 or customized PSAs with the library/organization's name or website for $145. It provides instructions for customization and contact information for billing questions.

1. “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