Account Application Form


Please complete the form below and click submit. We also need to see the following items in order to activate your account:
For the first few hires we ask for payment up front to gain a trading relationship. We accept cash, debit or credit card (2.4% surcharge on credit cards).
A copy of your Broadcast Hire / Production Insurance, to show that our equipment is covered while in your possession. Example companies listed below.

Local Insurance:

  • Towergate – 0344 892 1636
  • Aaduki – 01837 658 880
  • Media Insurance Brokers Ltd – 0207 2875054
  • Three forms of ID (i.e. driver’s licence / utility bill / passport etc).
  • Please do not hesitate to contact us should you have any questions.

    Company details


    Company name * Accounts Email *
    Contact Name * Nature of Business

    Contact Email * Registered company Address including postcode
    Company address including postcode *
    Company Registration No
    Tel No * VAT No
    Mobile * Credit Limit Request
    Fax No
    Company Website

    Bank Information


    Bank Name Account Name
    Bank Address including postcode Account No
    Sort Code
    Tel No

    Trade References


    Company name 1 * Company name 2 *
    Contact Name * Contact Name *
    Company address including postcode* Company address including postcode*
    Email * Email *
    Tel No * Tel No *
    Fax No Fax No

    Equipment Insurance


    Insurance Company Policy No
    Insurance Address Expiry Date
    Post Code Insurance Policy

    Please note: It is the responsibility of the hirer to provide adequate insurance cover to include all risks and any subsequent loss of hire.

    By signing the information below, I confirm that I have read and accepted Visual Impact’s Terms & Conditions

    Signature * Print Name *
    Preferred Office Of Contact: *

    Optional Message:
    Date * Where did you hear about us? *

    *If signing online just type in your full name

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    You can always change them later.


    Pick up date
    Return date RENTING FOR A WHOLE WEEK? PAY 4 DAYS ONLY
    RENTING FOR A WHOLE MONTH? PAY 12 DAYS ONLY

    PRICES WILL BE DISPLAYED BEFORE ANY DISCOUNTS ARE APPLIED
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    BY SHARING THIS LIST YOU UNDERSTAND THAT THIS PERSON
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    The kit has been cross hired

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