Personal Info:

Name

Home Address

Apt #

City

State

Zip Code

Home Telephone #

Work Telephone #

Cell Phone #

Fax # (For your Receipt/Invoice)

Email Address

Party Location Info:

Address of Party

Apt #

Private House

Restaurant  -  Name of Restaurant

Catering Hall  -  Name of Catering Hall

Community Room  -  Name of Community Room (if known)

Other (Please Fill In)

Floor

Cross Streets

City

State

Zip Code

Telephone # of Party Address

Type of Event/Entertainment Requested:

Birthday Party

Other (Please Fill In)

Enter Type of Event/Entertainment You Are Requesting (Example: Clown, Magician, Pony, Character's Name)

Event Date

Amount You Were Quoted by Great American Clown Company's Rep (Plus Tax)

START TIME (Time You Want The Performer To Start)

END TIME (Time You Want The Performer To End)

Birthday Person's NAME or GUEST OF HONOR

AGE

Amount of Guests

AGE RANGES

Payment:

Credit Card Number (Please enter as xxxx-xxxx-xxxx-xxxx)

Expiration Date

Name of Card Holder

CVV # on back of card (3 or 4 digit # at end of signature field on back of card)

Additional Comments/Special Instructions

2019 FUND DRIVE

Help put a smile on a sick child's face

CLOWN CARE PROGRAM

Visits from specially trained clowns to hospitalized kids as a cheer up.
"Laughter is the best medicine!"

PLEASE CONSIDER A DONATION

YES, I Would Like To Donate To DOC MAGIC Traveling Hospital Program

Amount of Gift:  $20  $25  $50  $75  $100  Other

Refund/Cancellation Policy:

Deposit: A 50% or less deposit is required for all private parties.

All deposits non-refundable.

Exception: "Act of Nature/Man" Full refund.

If this is a "Corporate" Event - Some clients such as Libraries, Museums, Camps, Known Fortune 500 Companies, etc.. are eligible for billing system.