Video tape CLEANING FORM Use this form ONLY for video tapes sent in for cleaning. Those that need repair must be accompanied by the Media / AV Services Repair Form.

Library name: ______________________________________________________

Contact Person: ____________________________ Phone: __________________

Sent to MHLS on (date): _______________

		MHLS Use Only
	Title	Cleaning Charge $3 per video
1	.
2	.
3	.
4	.
5	.
6	.
7	.
8	.
9	.
10	.
Total charge to be invoiced to library for Items

Print this form, complete the information on top and list the items included. Send the original with your materials. Retain a copy for your records.

Send items to MHLS Media / AV Services Department. Do not send more than 10 items at a time. No audio tapes will be accepted.
-----------------------------------------------------------------------------------------------------------------------

for MHLS use only

Received at MHLS: ______ Returned by MHLS: ______Invoice #: _________