Contact Information

Business Name

Contact Name

Contact Phone Number

On-Site Contact Name

On-Site Cell / Phone

Email Address

Mailing Address

Town / City

Province/State

Postal/Zip Code

Event Information

Event

Booth Location

Booth Number

Service Information

Service Start Date

Service End Date

Hardwired or Wireless Connection?

Hardwired: Number of Modems Required (1 modem per computer, enter 0 if none):

Wireless: Number of Computers (1 wireless connection per computer, enter 0 if none):

Rates (exclusive of taxes, subject to change)