EmailMe Form - TV & Film Hire

Section 1

Please provide us with your details so we can send you all the relevant information

Production name

Company Name (if Applies)

Your Name

First Last

Phone

Email

Address

Street Address Address Line 2 City State / Province / Region Postal / Zip Code

Section 2

Start and Finish date and Times

Date Starting

MM / DD / YYYY

Date finishing

MM / DD / YYYY

Approximate Start Time

HH : MM AM/PM

Approximate Finish Time

HH : MM AM/PM

Number of days required

Section 3

Please provide information medical staff required

Medical staff required

Paramedics

Technicians

Emergency care assistance

Please tell us as much about the medical provisions you require *

Please tell us what you require

Ambulance Car

Ambulance

Staff only

Location of Film/TV set

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Agreement and Invoice details

Terms and Conditions of hire:

I agree to pay the full cost to South Coast Medics Event & Ambulance Services Ltd Via bank transfer 14 working days after the invoice has been issued. I understand that failure to do so will result in late payment charges being added to the original invoice until the invoice has been settled. *

I AGREE

Invoice Details *

Please include
E-mail address
Company address
Contact name and phone number

Please tell us how you found this form *

Section 4

Admin Only

Price per day

£ Pounds . Pence

Date and Time available to clinet

Yes

No

Admin Notes Only