Client Registration Form

Client Registration Form

Register as a client and agree to our terms of service for Nathan Patrick Media
Full Name*

First NameLast Name
Email Address*
example@example.com
Phone Number*
Please enter a valid phone number.
Company/ Brokerage Name
Address (optional)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Which statement best describes you and your registration:

I'm an individual at a licensed brokerage and my certification and consent pertains to my orders or requests only.I'm a manager or Officer of a company and my certification and consent below is general and covers all photo shoots and services any agent at my company orders or requests.
Payment Responsibility Agreement/Certification*

I understand that all projects will be billed to my company’s monthly invoice if a vendor relationship has been established. If no such agreement exists, or if my company does not honor payment, I agree to be personally responsible for all charges for services and products related to this project.Payment may be made by credit card (Square), Zelle, or Venmo.If I am responsible for payment and my company requires internal work orders for marketing requests, I agree to submit all required requests to ensure projects are paid in accordance with my company’s policies.
Should be Empty: