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.Format: (000) 000-0000.
Company/ Brokerage Name
Address (optional)

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
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.
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.
By checking the link below, you agree to and accept the Terms of Services/Terms and Conditions: (Click Here for a direct link to the terms of Service/Terms and Conditions)
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