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Request for DVD of Riverside TV Programming (Print Only)
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This form has been modified since it was saved. Please review all fields before submitting.
The cost DVD is $20. Payment is due at time of application submittal. Checks should be made out to the Village of Riverside. If a DVD cannot be made for any reason, the fee will be returned. Normally, DVDs will be ready within 15 business days; however, processing may take longer depending on the availability of staff. You will be contacted by the Village 1) if the DVD request is delayed and 2) when the DVD is ready.
Name of Applicant
Phone Number
Address
City
State
Zip Code
Name of the Program Recording
Email
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
I agree.
Electronic Signature
Initials of Employee Receiving Request
Date Received
Date Received
Date notified by email
Date notified by email
Fee Received
Yes
No
2 Week Follow-Up Date
2 Week Follow-Up Date
Date of Applicant Pickup
Date of Applicant Pickup
Notes
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