Name _______________________________________________________
Address _______________________________________________________
_______________________________________________________
Note: Please use the above space to give us your home billing address for your
credit card. The address on the account must be the same as the billing address for
the credit card given or your application will not be accepted. If you would like to use a
different shipping address please attatch a separate page indicating the address to use
for shipments.
Telephone: (Home) ____________________ (Office) ______________________ Fax: ____________________________ E-Mail: ______________________ Driver's License # _______________________________ State _________ Credit Card #* _______________________________________ Expiration Date ______________________________________
*VISA or MasterCard only, please.
We ask for this number as a guarantee for our cassettes. If you do not have a credit card you must send us a check or money order for $50.00 per film rented. This will be returned to you when we receive our cassettes.
How did you hear about us? __________________________________________
Membership is non-refundable and will expire one year from date of signature unless renewed. By signing I hereby authorize VERSION FRANÇAISE to charge my credit card account for any rental fees, late fees and for films lost, damaged or not returned by seven (7) days from due date. I understand that the price per cassette is $50.00 or its replacement cost, whichever is higher. In the event collection activity is necessary to collect any outstanding balance, I accept that I am liable for all attorney fees, collection fees and costs associated with the collection efforts. Terms are subject to change without notice.
Signature _________________________________ Date ___________________
Mail to:
The French Video Club
4930 Saint Elmo Avenue, Bethesda, MD 20814
Fax : (301) 656-1658
Tel: (800) 835-7537