CREDIT CARD AUTHORIZATION

WE DO NOT ACCEPT AMERICAN EXPRESS

Production reference # * 🛈

Production Title * 🛈

Production Company *

Name on Card *

Credit Card Type *

Credit Card Number *

V-CODE - VISA, MC, DISC. LAST 3 DIGITS ON REVERSE *

Expiration Date (mm/yy) *

Credit Card Holder's First Name *

Credit Card Holder's Last Name *

Billing Street Address *

Address Line 2

City *

State *

Zip Code *

Credit Card Holder's Phone Number *

Credit Card Holder's Email Address *

PLEASE ATTACH SCAN/PHOTO OF CREDIT CARD (FRONT) * 🛈

PLEASE ATTACH SCAN/PHOTO OF CREDIT CARD (BACK) * 🛈

(DRIVER'S LICENSE) OF CARD HOLDER- PLEASE ATTACH SCAN/PHOTO * 🛈

Amount Authorized:$2,000

NOTE: SECURITY DEPOSIT WILL BE CHARGED 5 BUSINESS DAYS PRIOR TO FIRST SCHEDULED SHOOT DATE.

I UNDERSTAND I AM LIABLE FOR ANY UNPAID BALANCE OF THIS PURCHASE OR RENTAL (SEE BELOW)

CANCELLATION FEES, DATE CHALLENGES, PURCHASES, DAMAGE TO SETS, PROPS, EQUIPMENT, GRIP & LIGHTING, LOST OR NON-RETURNED EQUIPMENT, RENTAL CHARGES, LATE EQUIPMENT RETURN, EXTENDED RENTAL CHARGES, STAGE MANAGER OVERTIME, BAD CHECK FOR ANY REASON, EXPENDABLES, FUEL OR MILEAGE CHARGES OR ANY OTHER CHARGED COVERED IN THE RENTAL AGREEMENT OR BILL OF SALE.

I ALSO UNDERSTAND THAT I AM NOT HELD TO ANY SPECIFIC AMOUNT OF AUTHORIZATION. I AM LIABLE FOR ANY UNPAID BALANCE OF THIS PURCHASE OR RENTAL. I ALSO UNDERSTAND THAT AN ADDITIONAL 5% FEE WILL BE ADDED TO ALL CREDIT CARD OR DEBIT PAYMENTS.

I ACKNOWLEDGE THAT A COPY OF THIS DOCUMENT SHALL CONSITUTE THE SAME CONSENT AS AN ORIGINAL.

Type your full name here *

Credit Card Authorization Signature: By signing as card holder, I DO HEREBY AUTHORIZE SILVER DREAM FACTORY TO CHARGE MY CREDIT CARD AND UNDERSTAND AND HAVE READ ALL THE STIPULATIONS & TERMS TO THE ENTIRE LOCATION LICENSING AGREEMENT. I ALSO ACKNOWLEDGE THAT I AM A PRODUCER AND OR AN EXECUTIVE PRODUCER, LINE PRODUCER FOR THE PRODUCTION. *

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