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Please complete the following. Items in red are required. After selecting your packaging type, please enter all information in the box related to that selection.

Business Name:
Your Name:
Phone:
Fax:
e-mail:
Your Web Site (If You Have One):

Would you like us to send you a copy of our quality sampler?

Address is required, even in not requesting a sampler.

Shipping Address:
Shipping Address (2):
City:
State:
Zip Code / Zone:
Country:

When do you expect to have the project ready for manufacturing? (if known)
Where did you hear about World Media Group?
How many CDs did you have replicated last year?

Project Name:

Quantity:

Disc Length:

Disc 1: Min : Sec and/or Mbytes data

Disc 2*: Min : Sec and/or Mbytes data

Disc 3*: Min : Sec and/or Mbytes data

Disc 4*: Min : Sec and/or Mbytes data

Disc 5*: Min : Sec and/or Mbytes data

Disc 6*: Min : Sec and/or Mbytes data

* Multi-Disc Sets only

Disc Type:

Source Type:

Pre-mastering or assembly needed?:

Disc Printing:

Number of colors:	1 Color 2-Color 3-Color 4-Color 5-Color Offset (Photo Quality)
Film and proof supplied:
Properly formatted artwork supplied on WMG template:
Design required:

Packaging:

Bulk (no packaging)

Jewel Case (Single CD)

Jewel Case ( Single-width, 2 CDs)

Jewel Case (Double-width 2-6 CDs)

Paper Sleeve

Tyvec Window Sleeve

Univenture Sleeve

Other Sleeve

RF Blister Pack

If "Jewel Box" checked, complete these options

Shrink Wrapped Yes No

Jewel Box Color
Tray Color

Booklet/Insert

None
Provided
Printing Needed

Single Panel
Booklet style, Number of pages:
Folder style, Number of pages:

Colors, Outside:
Colors, Inside:

Quantity (1000 min):

Tray Card

None
Provided
Printing Needed

Colors, Front/Outside:
Colors, Back/Inside:

Quantity (1000 min):

Front Tray Card (Double-Width Jewel-boxes only)

None
Provided
Printing Needed

Colors, Front/Outside:
Colors, Back/Inside:

Quantity (1000 min):

If "RF Blister Pack " selected, complete these options:

Blister Pack Style:

(Note: RF Seal package will contain a CD in a standard Jewel box. You must also fill out the section above for Jewel box packaging)

Display-Card Options
Display-Cards Supplied
Printing Required

Colors, Front:
Colors, Back:
Quantity (2500 min):

	Film and Proof Supplied
	Properly-formatted Computer Artwork supplied (on WMG Template)
	Design Required

Stickering

None
Provided (apply only)
"Strong Content" Warning
Custom Design

Reply Card/Additional Insert

None
Provided (Insert Only)
Printing Needed

Notes (special requirements, etc.):

Indianapolis		Dallas		Los Angeles		Nashville		New York
800.400.4964		927.839.2054		805.300.7463		800.874.4174		212.947.4550
Headquarters		Southwest Sales		West Coast Sales		Midsouth Service Center		East Coast Sales