Great American Clown Company

Request for Information
Reservation Form

NOTE: Please only fill out form if a Great American Clown Company rep has requested you to do for your event.

Personal Info:


Home Address

Apt #



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)


Cross Streets



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: Clowns, Magic, Puppet Shows, Petting Zoo)

Event Date

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

START TIME (Time You Want The Performer To Arrive)

END TIME (Time You Want The Performer To End)

Birthday Person's NAME or GUEST OF HONOR


Amount of Guests


Do you need a Webmaster?


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

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.