Company One Productions Logo
Grip, Lighting, and Electric Services & Rental
for Motion Picture and Television.

Payment Information

Authorization to Use Credit Card

Name on Credit Card

Billing Address on Card

City                                                State                         Zip

Tel                                          Fax

Email                                                               Social Security #

Driver’s license #

Company Name on Card

Company Address

Card number

Expiration date                                               Security Code

Type of card    visa            mastercard               amex

Customer name

Address

City                                               State                         Zip

Tel                                          Fax

Location Phone and contact

I hereby authorize Company 1 Productions, LLC and its successors and assigns to charge to the above captioned credit card any rental fees, security deposit, missing and/or damaged equipment fees, or any other fees or charges related to any purchase, rental, repair or any other service provided to the above named customer. I was given an opportunity to review Company 1 Productions, LLC’s Terms and Conditions and I hereby agree to same.

It is further agreed that any dispute related to credit card debits shall be governed by Company 1 Productions, LLC’s Terms and Conditions.

I also agree that any balance remaining due after 30 days for the above named client may be charged to the above credit card.

Agreed to and accepted by:

Signature                                                   Date

Please print name and title