Event Date Request Form
(Fill in all blanks)
Type of Event
Choose One
Birthday
Church Event
Company Event
Fund Raiser
School Event
Other
Organization Name
Contact Person
Name of Event
E-mail
Event location:
Address
City
State
Choose a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
D.C.
Delaware
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Date
Month
January
February
March
April
May
June
July
August
September
October
November
December
/
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
/
Year
2009
2010
2011
2012
2013
Start Time
01
02
03
04
05
06
07
08
09
10
11
12
:
00
30
AM
PM
Length (hours)
1
2
3
4
5
6
7
8
9
10
End Time
:
Phone
Mobile phone
Fax
Check Games Requested
(1) Mobile Laser Tag w/staff
(1) Inflatable Air Bots w/staff
(1) Inflatable Bouncer Maze 3.0
(1) Inflated Obstacle Course w/staff
(1) Jungle Combo Bounce House Slide w/staff
(1) Princess Pink Castle Bounce House w/staff
(1) Sports Arena Bounce House w/staff
(1) Wizards Castle Bounce House w/staff
(1) Inflatable 22' Tropical 2 Lane Slide w/staff
(1) Inflatable Twisted Twister Slide w/staff
(1) Inflatable Tent
(1) Boomers Fun Factory w/staff
(1) Inflatable Water Slide with Pool
(1) Inflatable 22' Tropical 2 Lane Slip 'N' Slide Combo w/staff
(1) Pitch Burst w/staff
(1) Down Pour Derby w/staff
(1) Trackless Train w/ Staff
(1) High Striker w/staff
(1) Soccer Kick Game w/staff
(1) Duck Pond Game w/staff
(1) Cork Gun Game w/staff
Wind Dancer
Enter Number Of Food Items Requested
Pucker Powder 32" Tube
Pucker Powder 18" Tube
Pucker Powder 12" Tube
Pucker Powder 6" Tube
Pucker Powder Mini
Trip Fee
Pucker Powerder Party Kit
East Coast Trip Fee
turtles
6000 watt Generator
Are You Tax Exempt?
YES
NO
(
If YES, Please provide certificate
)
Comments/Questions
