download a .pdf of this form.

  1. Print out this form.
  2. Complete this form in full and mail a check made payable to MMSD-TV to:
    MMSD Media Production, Rm 222
    545 W. Dayton St.
    Madison, WI 53703
  3. Duplication Guidelines
    • Fill out one order form for each video program requested.
    • Cost = $10.00 per DVD ($12.00 per graduation DVD).
    • Check or Money Order only.
                                  Sorry, we cannot accept cash or credit cards.
    • Allow 4 - 6 weeks for delivery.
    • Copy will be sent via U.S. Mail to address provided.
    • Fee for service must be paid in advance.
    • Duplication services limited to no more than 5 copies of any program per year.
Name of MMSD-TV program to be duplicated:__________________________________
(Please describe the program if title is unknown.)
Your name:                                                                       
Your phone:                                                                        
Your address:                                                                      
Your City:_______________________________State:         Zip:                      
Your e-mail:                                                                       
Number of copies:

1 2 3 4 5 $10 per copy  ($12.00 per graduation DVD)

Check or Money Order only.
Sorry, we cannot accept cash or credit cards.

For schools or MMSD account billing the duplication fee = $2 per copy.
Please provide General Supplies Account Code below:

MMSD complies with all copyright laws.