Telephone 978.884.9518 • 15 Jodi Drive Tewksbury MA, 01876
or just email questions to transfers@thirdmanmedia.com

Please Contact Me on the Following Services: (check all that apply).

	What are your needs:	Filming		Mastering		Web Maintenance
		Editing		Restoration		Print Design
	Web Design	Scoring		Film Conversion		Illustrations

Other needs or list details for selected services for
Filming, Scoring, or Design Services.

Your originals are currently on: (check all that apply).

	If Film Convertion and or Restoration, I have this type of media:	8 or 16 MM film		Hi 8 Video		VHS Video Cassette		Betamax Video Cassette
	Film Media (still photography)	4 x 5 or 120 Positives or Negatives		35 mm Slides or Negatives		Photograph Prints		Documents

If "Other" Describe

First and Last Name
Address
Suite or Mail Stop# (if any)
City		State		Postal Code
Phone
e-mail
web site (if applicable)