Secure Authorization

Credit Card Authorization Form

Please complete this authorization form for LA Film Rentals. This helps us verify payment authorization, rental responsibility, and billing approval for approved equipment rentals.

Before submitting: Please make sure all billing, contact, rental, and authorization details are accurate before sending this form.

Credit Card Authorization Form

Step 1 of 3

Do you currently Have Production Insurance?

Annual Insurance
Short Term Insurance
No Insurance
CC Deposit

Credit Card # *

CCID *

3 or 4 Digits on Front or back of card

Expiration Date *

Billing Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Front of Card Image Upload

Drag & Drop Files, Choose Files to Upload, or Capture With Your Camera

Back of Card Image Upload

Drag & Drop Files, Choose Files to Upload, or Capture With Your Camera

I agree to use this card for rental and/or deposit

I Agree

Signature

Clear Signature