Customer Info

PLEASE ISSUE COI WITH THE FOLLOWING INFO:

Brinker Media Group, Inc. DBA Atlas ATL PRoductions

127 Center St.

Avondale Estates, GA 30002

GEAR LIST

REQUESTED PICKUP DATE

Date of gear prep / pickup

MM

DD

YYYY

NUMBER OF SHOOT DAYS

How many active production days?

REQUESTED GEAR RETURN DATE

Date of gear return / dropoff

MM

DD

YYYY

JOB NAME

Please enter in your production name or associated job description.

CONTACT NAME

First Name

Last Name

Producer Contact Name

LEGAL PRODUCTION COMPANY NAME*

Email

Phone

(###)

###

####

BILLING NAME

INVOICE BILLING ADDRESS

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

INSURANCE COMPANY NAME

1ST AC NAME

First Name

Last Name

PROFESSIONAL RENTAL REFERENCE

Please include one rental house reference for us to contact.