SAFETY TRAINING DVD REQUEST FORM

Please allow at least 7 to 10 business days from the date you send in your request to receive DVDs. Adequate time for handling and mailing is critical in order to insure your selection reaches you by your requested training date. Public Entity Partners Safety DVD Library is shared among all members, and your requested material might already be loaned out.

Name of person making request*

City/Agency and Department*

Mailing Address*

City*

Zip Code*

Email*

Phone Number*

Maximum of 3 DVDs may be loaned for up to 2 weeks* (Must Select at least one (1) to submit form)

Please select two alternative choices if above DVDs are out of stock

Request Date*

I agree, upon signing this SAFETY TRAINING DVD REQUEST FORM, to be held responsible for the DVD and that DVDs are returned in a timely manner and in GOOD CONDITION. Failure to do so will result in the signee having to PAY for the cost of replacing the DVD. All returned DVDs should be in tear-proof material via UPS, Federal Express or U.S. Postal – Express or Priority. If DVD is lost in the mail or scratched, you are responsible for replacement cost. Please respect the copyright law on all DVDs.