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

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.