Commercial Returns Form

Please complete all fields and return to Filmbankmedia on the last day of your screening(s). You will require your 'Confirmation of Booking' to use as a reference.

Organisation Name *

STSL Account Reference No.

Your Name *

Telephone *

Email *

Venue and Screening Information

Title of Film Screened *

Start Date of Screening *

LA (Licence Agreement) No. *

End Date of Screening

Total No. of Screenings *

Box Office Takings

Adult Ticket Price *

Concession Ticket Price *

Other (ie Child) Ticket Price *

No. of Adult Tickets Sold *

No. of Concession Tickets Sold *

No. of Other (ie Child) Tickets Sold *

Total Box Office Takings (inc. VAT at 20%) *

I confirm that the above screenings took place under the Terms and Conditions of a Commercial Filmbankmedia Licence and that the information contained in this Commercial Returns Form is, to the best of my knowledge and belief, true and correct. I understand that Filmbankmedia has the right of audit on this information and if Filmbankmedia deems it necessary, I will provide Filmbankmedia with full rights of unhindered access, reasonable physical conditions and all necessary facilities in which to conduct any audit.

Please tick to continue. *