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City: __________________________________________________________________________
Request Date: ___________________________________________________________________
Date Needed: ___________________________________________________________________
Person Making Request: ___________________________________________________________
Department: ____________________________________________________________________
Phone Number _______________________________________
Video Number and Title Needed: (No more than 3)
_______________________________________________________________________________
_______________________________________________________________________________
Address where videos are to be shipped
_______________________________________________________________________________
_______________________________________________________________________________
FAX this form to Starr Markworth, MVRMA
(937) 438-8330 or email request to smarkworth@mvrma.com
Please allow 3-5 days for delivery by mail. To make other arrangements, please call the MVRMA office at (937) 438-8878.
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