Film Request Form

Today's Date

ORE Reservation #

ORE Contact

Reservation Date Requested

Reservation Location

Organization/Dept name

Representative Contact Name

Title

Representative Email

Representative Phone Number

Mailing Address

Adviser's Name

Adviser's Phone Number

Reservation Instructions

Your reservation request to show a movie is tentatively scheduled at this time.
Mark Leners will notify you by e-mail, the information regarding the availability, rental and shipping cost of the requested film.
Within 24 hours of receiving the requested film information, you must respond by e-mail to Mark Leners (mark.leners@vanderbilt.edu), to accept and confirm the terms of the film rental request.
Please provide a center number in the field below or provide an 1180 signed by the student organization’s adviser for film rental and shipping charges. This must be delivered to Mark Leners at 105 Sarratt Student Center (behind the Sarratt Information Desk) within 24 hours of your acceptance. The film will not be ordered until the above is completed.
After the completion of the above procedure, Mark Leners will provide ORE a copy of this completed form. Your reservation status will be changed from tentative to confirmed.
Mark Leners will also provide the Technical Services department a copy of this completed form so they will have the necessary information to set up your film.
You will be billed at the end of the month by ORE for technical services.

Film Title

Rental Fee (To be filled in by office)

Shipping Charge (To be filled in by office)

Run Time (To be filled in by office)

Film Format (To be filled in by office)

Rental Charges 1180 # (optional)

Center Number

Date To Play

Additional Notes