MEMBERSHIPS: Sign up / Renew | VIDEO ROOM | New York City Video Store

Please fill in all fields below. All membership renewals will begin upon expiration of your current annual membership.

Membership Type:

Silver Club (FREE)
Gold Club ($89)
Platinum Club ($250)

First Name:

Last Name:

Phone:

Email Address:

Mailing Address: Apt. #:

Nearest Cross Street (Gold & Platinum Members only):

ZIP Code:

Names of Other Authorized Renters
(Same Household Only):
(one person per line please)

Enter names of other authorized renters in your household here (one person per line)

How You Learned About VideoRoom:
(check all that apply)

Newspaper Ad
Magazine Ad
Flyer
Yellow Pages
Internet
Passing By
Friend
Other

Credit Card Type:

Credit Card Number:

Credit Card Expiration (MM/YY):

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I AUTHORIZE VIDEO ROOM TO BILL MY CREDIT CARD RENTAL CHARGES, WHEN SO INSTRUCTED, OR AS PAYMENT FOR DELINQUENT, DAMAGED OR NON-RETURNED TAPES