Visual Effects LLC - Rental Agreement

 ___________________________________              ___________                      __________________________________
First Name                                                                      Middle Initial                        Last Name

 ______________________________________       _____________________               ________             ____________
Address                                                                                       City                                         State                       Zip Code

(________)________-___________             (________)_______-___________               (_______)_______-___________
Home Phone                                                      Work Phone                                                         Cell Phone

_____________________________               __________________________        ________            _____/_____/_____
Email Address                                                      Drivers License Number                     State of Issue        Expiration Date

                                 ______/______/______                                                                                   ______/______/______  
Date of Birth *:     Month /   Day   /  Year                                                  Anniversary Date *:  Month /   Day   /  Year         

 * Come in for your free video rental and tanning session on your birthday and anniversary. Sorry this is not transferable
and must be used on your actual birthday. Account must be in good standing to be eligible for free movies and/or tanning..

 Please list the immediate family members that you would like to rent movies on your account.

 ________________________        ______       ________________________   _____/_____/_____          ____________
First Name                                           M.I.              Last Name                              Month/ Day  /  Year             Max Rating

 ________________________        ______       ________________________   _____/_____/_____          ____________
First Name                                           M.I.              Last Name                              Month/ Day  /  Year             Max Rating

 ________________________        ______       ________________________   _____/_____/_____          ____________
First Name                                           M.I.              Last Name                              Month/ Day  /  Year             Max Rating

 ________________________        ______       ________________________   _____/_____/_____          ____________
First Name                                           M.I.              Last Name                              Month/ Day  /  Year             Max Rating

 ________________________        ______       ________________________   _____/_____/_____          ____________
First Name                                           M.I.              Last Name                              Month/ Day  /  Year             Max Rating

Ratings: G, PG, PG-13, R, NR (Not Rated)

Terms and Conditions:
Customer agrees to be responsible for any loss or damage to rented property.
Customer agrees to pay late fees when rented items are not returned by 6:00 PM of the due date.
Customer agrees to pay all collection fees incurred by Visual Effects LLC in order to collect under this agreement.
Customer agrees not to copy or duplicate any portion of the content contained on the rented items.
Customer agrees that rented items will remain the property of Visual Effects LLC at all times.
Customer agrees that no warranties exist, either implied or expressed, on rented items.
Customer agrees to pay all charges that apply to rented items whether customer uses them or not. Failure to return rented
property may result in criminal prosecution.
Customer agrees to all terms of this agreement for all items rented by immediate family members as listed above.

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Customer Signature                                                                                                                                             Month /   Day   /  Year