Customer Account Request Form

Company Name*

Company website address

Primary contact's full name (The primary contact will be automatically be registered as the account administrator for your company once the company account has been authorised for use)*

Telephone number

Email*

Company address, including postcode/zip code*

Secondary contact's full name

Telephone number

Email

Invoicing contact's full name (if differs from primary contact)

Telephone number

Email

Invoicing address (if differs from main address)

Country*

VAT number

Type of company Theatrical? i.e. Cinema releases*

YesNo

Video? i.e. Home releases such as DVD or Blu-ray*

YesNo

Digital video service? i.e. VOD, EST etc...*

YesNo

Ad agency? **

YesNo

Record Label i.e. Select this option if you want to deliver short form music videos for online classification - otherwise select 'Video'.*

YesNo