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CONTACT INFO
First Name*
Last Name*
Business Name
Phone*
Email*
Producer Name*
PRODUCTION INFO
Title*
Budget*
Synopsis*
Coverage Dates*
Date you're picking up the equipment*
MM slash DD slash YYYY
Date you're returning the equipment*
MM slash DD slash YYYY
CUSTOMER VERIFICATION
Driver's License #*
Upload FRONT of Driver's License*
Max. file size: 256 MB.
Upload BACK of Driver's License*
Max. file size: 256 MB.
Upload 'Selfie'*
Max. file size: 256 MB.
Provide one or more names and tel numbers as references*
URL link to your IMDb Page (if available)
YOUR SIGNATURE
By entering your name in the “YOUR SIGNATURE" field below, you will be confirming that this Production does not include any of the following: Stunts, Fight Scenes, Guns, Pyrotechnics, Pornography, Live “Gangster Rap” Music, Filming outside the USA, Filming from above 15 Feet. You will also be confirming that you understand that this insurance will only be for this specific production.
YOUR SIGNATURE (Enter your name here)*
Email
This field is for validation purposes and should be left unchanged.

CONTACT INFO