DVD & CD-ROM Intellectual Property Rights (IPR) Form

* All required fields are bold and highlighted in blue.

Customer Information

Quotation Number (QT#)	Please enter your quotation number (QT#) found in the upper right of your quote form (required)
Customer Name	Please enter your first and last name (required)
Project Name	Please enter your project name (required)
	*Please Note: If you are ordering Spine Labels, the "Customer Name" and "Project Name" info will be used to create it.
Company/Label Name	Please enter your company or label name (optional)
Address Line 1	Please enter your address line 1 (required)
Address Line 2	Please enter your address line 2 if applicable (optional)
City	Please enter your address city (required)
State	Please choose your address state (required)
Zip Code	Please enter your address zip code (required) [ ex. 55555 or 55555-5555 ]
Country	Please enter your address country (required)
Email Address	Please enter your email address (required)
Phone Number	Please enter your phone number w/ area code (required) [ ex. 555-555-5555 ]

Project Information

Project Type (CD-ROM, DVD-ROM, DVD-Video)

I understand that if I am not the owner of all the intellectual property rights for the entire contents on this disc, and any supplied artwork, I am required to purchase and provide documentation for licensing from the owner or owners of the intellectual property rights of the content. This includes any software, freeware, music, photos, video, shareware, and any other licensed content. For additional information please refer to: www.discmakers.com/copyrights

Digital Signature

PLEASE READ: I affirm that all information provided herein is true and complete and that all disc contents indicated as being “licensed” are properly licensed for manufacturing (replication, duplication, and/or printing) under the terms of the license from the intellectual property rights owner(s). I further declare that I am the intellectual property rights owner for all contents indicated as being "owned" by me. I authorize the duplication and replication of all content owned by or licensed by me. I understand that in accordance with Disc Makers’ Anti-Piracy Compliance Program procedures and standards, Disc Makers reserves the right to refuse the processing of any order not complying with the Anti-Piracy Compliance Program guidelines. No order is effective until accepted by Disc Makers and is subject to the Terms and Conditions of Sale.

	I, , have read and agree to the terms above.
	By checking this box, I am certifying that I am authorized to sign this agreement. I affirm that my agreement here constitutes an electronic signature and that this signature meets any and all requirements for an original signature and is legally binding in all respects.

(Please do not print this form out to complete by hand and mail in. For further assistance, please contact your Product Specialist.)