Download Form

You can download the form, print it, and fax it back to us:

> Adobe PDF

> Microsoft Word


 

New Customer Form:
Corporations, LLCs, and Companies

*=Required fields. If you are not a corporation, LLC, or company,
please use the form for individuals or partnerships.

 

PART 1 of 5: Create a BudgetVideo.com Account

You'll be able to create quotes, review your rental history, and update your information.

First Name*
Last Name (Surname)*
Enter your name or the name of the appropriate person at your company.
If you've already spoken with an agent at Budget Video, enter their name in the "Rental Agent" field.

Email Address*
Rental Agent at Budget Video
Email addresses are never sold or shared and are only used by Budget Video.

Username (6-24 chars)*
Password*
Verify Password*



Approximate REPLACEMENT VALUE of the equipment being rented:*

 


PART 2 of 5: Company Information

The more information you provide, the faster we can verify your account.
If you are NOT A COMPANY please use this form.

Company Name*
Company Type:
Permanent Address* (no P.O. Boxes)
 
City*
State*
Zip*
Country
 

Billing address same as physical address

Billing Address *
 
City*
State*
Zip*
Country
 


Phone
Fax
Mobile
 
*at least one phone number is required.


Federal Tax ID (FEIN)
DBA (if applicable)
 
Year Started
Incorporated in Which State?
 
Parent Company (if applicable)
Parent City, State
 
Business Description

For example, "Production Company", etc.
Business Web Site
 

Company Facebook

Like Us: facebook.com/BudgetVideo
Company Twitter

Follow Us: twitter.com/BudgetVideo
 

Require Purchase Orders
 
List persons authorized to place orders:

Enter Full Names, One Per Line.
 


PART 3 of 5: Officer Information

The more information you provide, the faster we can verify your account.
This information is NOT STORED in our database or anywhere else
and will only be used to verify your account.

Name of President or Authorized Officer*
Position of Officer*
Driver's License Number
State
Issue Date
Expiration Date
Date of Birth
Social Security Number
 

Officer's Email Address (if different than above)

Email addresses are never sold or shared and are only used by Budget Video.
 


PART 4 of 5: Professional References

All applicants must provide references for a Cash And Carry account. A professional reference is a company or person who you do business with, preferably one in which you have established credit or someone you have worked with in the industry.

Reference 1

Full Name*
Company Affiliation*
 
Address*
 
City, State, Zip*
 
Phone*
Fax
Email Address
 

Reference 2

Full Name
Company Affiliation
 
Address
 
City, State, Zip
 
Phone
Fax
Email Address
 

Reference 3

Full Name
Company Affiliation
 
Address
 
City, State, Zip
 
Phone
Fax
Email Address
 


PART 5 of 5: Bank Reference

Name of Bank
Bank Contact Name
 
Branch Location
 
Bank Phone
Fax
Account Number
 

All information entered on this form is warranted to be true and is for the purpose of establishing an account at Budget Video Rentals. I authorize Budget Video Rentals to contact my references and verify the information in all fields.

Digital Signature: (Full Name)*