NC Road & Highway Use / Assistance Request

Applicant
Title of Applicant
Title of Production
Type of Production
Production Company
Address
City
State
Zip
Phone
Cell
Fax
Email
Producer
Director
Insurance Company
Policy #

UPM
Phone
Cell
Email

Location Manager
Phone
Cell
Email


	Traffic Control Request*
	Bridge Closure Request*
	Road Closure Request*


* The NC Film Office will contact the Highway Patrol when deemed necessary; they, in turn, will make every effort to use local law enforcement authorities; You are encouraged to hire off-duty officers for your needs.

Date of Set-up
Time Window (ex: 1pm-3pm)

Date of Production
Time Window

Date of Tear-down
Time Window


Exact location of shoot (city/town, intersection, name of bridge, mile marker, etc.
Base camp location
Total number of personnel
Children? If so, number
Animals? If so, kind and number

Stunt work? Describe stunt work
Aircraft? Name of pilot(s), flight company/contact info
Vehicles? Number and types
Additional Information

The NC Film Office will contact the State Department of Transportation and State Highway Patrol on your behalf. Either or both agencies will contact you with 48 regular business hours and provide assistance and/or advice on your project.

By submitting this form I ATTEST that the information provided on this form is complete, correct and in no way misleading or false. I am fully authorized to represent the production/applicant stated and will work with NC state officials to adhere to their safety regulations to protect property and lives.



NOTE: THE NC FLIM OFFICE IS NOT A PERMITTING AGENCY. We work on your behalf with state agencies to secure proper permitting for your shoot.