New Customer Form

//New Customer Form
New Customer Form2019-01-31T22:59:57+00:00

Please take time to fill out our new customer form. This helps us get to know you and speeds up future orders. If you have any questions, please don’t hesitate to contact us.

Customer Type


Feature FilmTV ProductionCommercial Prod


StageRental HouseStudioSchool


GripGaffer/ElectricStudent


Other

Primary Address

Use As Ship To?
Yes

Billing Address

Same As Primary

Tax Status

TaxableNon-Taxable

Contacts

Credit Card Authorization


AmexMaster CardVisa


Same As Primary

I authorize Los Angeles Rag House Inc, to charge the above credit card for payment of rental or purchase fees.

Please upload a copy of your Resale Certificate here: