Contact Name *

Who we should ask for when arriving

First Name

Last Name

Hold Harmless Agreement *

I agree that this is an at will agreement. I will not hold Flarecorp Media or any of its affiliates or employees accountable for delays, lost sales, damages, negative publicity, or any other unwanted effects or outcomes arising from this filming. I understand I cannot expect the usual amount of work to be completed due to the demands of filming. By selecting agree, I affirm I have the authority to make this agreement on behalf of my company.

I agree

I disagree

Contact Phone *

Phone for who we can call with further communication

(###)

###

####

Is it okay to text this phone number? *

Yes

No

Filming Date *

We should have already discussed this, but please confirm when you are expecting us to film.

MM

DD

YYYY

Work Location Address *

Where should we arrive the day of filming? Keep in mind, this may not be your office address if the the filming is to take place somewhere else

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country