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        1. Contact Information

              Required Fields(*)

Name	*
Company/Event	*
E-mail Address	*
Work Number
Cell Number
Home Number
Fax Number
Address	*
City	*
State	*
Zip Code	*

        2. Event Information

              Required Fields(*)

Event Date	*
Location Name	*
Location Address	*
City	*
State	*
Zip Code
Telephone
Event Times	*
Attendance #	*
Type of Event

        3. Items of Interest to You

                                                  Inflatables:

            Dalmatian Bouncer                   Tiger Bouncer                

            Carousel Bouncer                    Monster Truck Bouncer        

            Dalmatian Bouncer 2               Castle 3-in-1 Combo

            Giant Slide Dual                      Jacobs Ladder

            Cash Vault                              Rock Wall Slide             

            Circus Train Crawl Thru          Rock N Joust           

            AC Obstacle Course               ACD Obstacle Course

            Bungee Run - 2 Lane               Mountain Climb

            Would you be needing event staff?    Yes    No

                                           Casinos:

        Blackjack                    Variety Poker           Texas Holdem

        Craps                          Roulette                    Cash Vault

        Holdem Tournament     Video Racing

            Would you be needing dealers?    Yes    No

                                        Others:

        Carnival Games           Performers               Pucker Powder

        Mini Donuts, Cotton Candy, Sno Cones

        Corn Dogs, French Fries

        Cheese Curds

        Hot Dogs, Brats, Hamburgers

        Catering Services         DJ Services             Karaoke

            Anything else you would like to tell us? 

            Other items your looking for?

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            How did you hear about us?

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          Vehicle Signs  Client Referral   Other

       4. Please Review and Submit