Request for Information
Home Telephone #
Work Telephone #
Cell Phone #
Fax # (For your
Name of Restaurant
Name of Catering Hall
Name of Community Room (if known)
(Please Fill In)
# of Party Address
Other (Please Fill In)
Enter Type of Event/Entertainment You Are
Requesting (Example: Clown, Magician, Pony, Character's Name)
You Were Quoted by Great American Clown Company's Rep (Plus Tax)
TIME (Time You Want The Performer To Start)
TIME (Time You Want The Performer To End)
Person's NAME or GUEST OF HONOR
Card Number (Please enter as xxxx-xxxx-xxxx-xxxx)
of Card Holder
# on back of card (3 or 4 digit # at end of signature field on back of card)
Additional Comments/Special Instructions
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:
Deposit: A 50% or less deposit is
required for all private parties.
All deposits non-refundable.
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