KAKE Video Dub Request - FILL OUT BELOW FORM FOR SHIPPING, BEFORE PAYING WITH PAYPAL

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You must BOTH submit the form and THEN pay using PayPal.  A PayPal account is NOT required, credit card payments are accepted.

1.Contact/Shipping Information
Today's Date*
First Name*
Last Name*
Street Address*
City*
State*
Zip*
Home Telephone*
Email Address*
2.Video Requested
Honor Flights
Santa's Workshop DVD
Other Video (Specify)
Date Story Aired
Number of Copies Requested
3.Story Appeared on KAKE TV at:*
5-7am 11am 4pm 5pm 6pm 10pm Honor Flights Santa's Workshop DVD
Other (please specify)
4.Please describe video*
5.KAKE-TV keeps newscasts on file for a limited period of time. No guarantee is implied the requested material is still on file.

KAKE-TV reserves the right to refuse any request.

Requests for copies of any material for use in litigation will require a subpoena.

Copies of any material for re-broadcast or re-transmission electronically is not permitted.

Only material that aired is available. Material not broadcast is not available.

Copies provided by KAKE-TV under this agreement are intended for private home use and may not be duplicated, re-broadcast or transmitted electronically. All material copied remains covered by copyright laws protecting KAKE-TV.

Please allow two weeks for completion and mailing. All copies will be mailed to the address listed on this form.

All dubs are on DVD.

If the request cannot be completed, payment will be refunded through PayPal.

Yes, I have read, understand, and agree to the above policies, Web site usage agreement and privacy policy.*
Yes, I agree
No, I do not agree
6.Date of Birth (Must be 13 years or older to enter this form)
Month* Day* Year*
* represents required fields
KAKE TV 1500 N. West Street Wichita, KS 67203-1323 (316) 943-4221
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