Request for DVD of Riverside TV Programming (Print Only)

2. 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.

   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.

4. Name of Applicant

5. Phone Number

7. Address

9. City

10. State

11. Zip Code

13. Name of the Program Recording

14. Email

16. 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.

    1. I agree.
18. Electronic Signature

20. Initials of Employee Receiving Request

21. Date Received
    Date Received

22. Date notified by email
    Date notified by email

23. Fee Received

    1. Yes
    2. No

25. 2 Week Follow-Up Date
    2 Week Follow-Up Date

26. Date of Applicant Pickup
    Date of Applicant Pickup

28. Notes

Leave This Blank:


29. Print Only

* indicates a required field