Name:
Address:
Phone#:
Fax#:
Email Address:
How would you like your quote returned?
E-mail
US Postal
By Phone
Fax
General Description of Event
Presentation
Training
Court
Law Office
Rehersal Dinner
Other
If "other" please explain
Number of Attendees (Approx)
Date of Event?
Time of Event?
Location of Event?
What equipment do you need?
Data/Video Projector
Document Camera (Elmo)
Slide Projector
VCR/DVD Player
A/V Cart
Wired Microphone
Wireless Microphone
Speaker System
Do you need a Screen for Video Projection?
yes
no
If "yes"
Front Projection
Rear Projection
Not Sure
What size Screen do you need?
Will the Equipment be connected to any on-site A/V (Audio,Video)equipment?
Yes
No
Not Sure
Other A/V requirements?
Delivery requirements
Delivery and Set-Up
Delivery Only
Will you need an on-site technician?
Yes
No
If "yes" how many hours?
Other Requirements needed for your event (explain here)
How will you be paying?
Company Check
Personal Check
Credit Card
Not sure at this time
Please fill out this form to submit your Rental request
Contact:
Leah Modisette
/ Business Manager
Kevin Modisette
/ Sales Manager
C
ourtrooms, Schools,
Churches,
Residential
S
erving the Greater East
Texas
area
Call
u
s (903)
2
42-9898
We Accept
