New Customer Form - LA Rag House

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.

Company Name (required)

Production Name (required)

Your Email (required)

Customer Type

Production Company
Feature FilmTV ProductionCommercial Prod

Facility
StageRental HouseStudioSchool

Individual
GripGaffer/ElectricStudent

Other
Other

Please Describe

Primary Address

Use As Ship To?
Yes

Number and Street Address

City

State

Postal Code

Billing Address

Same As Primary

Number and Street Address

City

State

Postal Code

Tax Status

TaxableNon-Taxable

State of Incorporation

FIN

Tax Exempt Number

Resale Number - (Please attach your resale certificate at the bottom of this form)

Contacts

Primary Contact

Job Title

Department

Email Address

Office Number

Extension

Mobile Number

Additional Contact

Job Title

Office Number

Extension

Mobile Number

Credit Card Authorization

Name as it appears on card

Credit Card Number

Type of Card
AmexMaster CardVisa

Security Code

Expiration Date (mm/yy)

Billing Address
Same As Primary

Number and Street Address

City

State

Postal Code

Country

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

I Authorize

Signature

Additional Notes

Please upload a copy of your Resale Certificate here: