2018 Vendor Electrical Information

In order to achieve superior service to all Country Jam vendors, the below electrical form MUST be filled out and sent to the office of Country Jam no later than April 30th, 2018.Food vendors will receive two (2) 20 AMP circuits of electricity. Hard good vendors will receive one (1) 20 AMP circuit of electricity.By submitting the form before or by May 31st, 2018 you will receive the pre-event pricing discount. A licensed electrician will be onsite during festival hours to provide with assistance if necessary.

Completing the Form

  • Fill out the information section, please do not leave anything blank. Signature and date are required.
  • Accurately fill out the Electrical Requirements. Any additions made onsite, will be charged.
  • Complete the Payment Method portion accurately.
  • Mail the form to arrive to the office of Country Jam USA no later than May 31st, 2018.
  • If you have any questions, please call 715-839-7500.

NOTE: Any Electrical Forms received after May 31st, 2018 will be charged event pricing.

Send to:

Country Jam USA

1711 S. Hastings Way

Eau Claire, WI 54701

Electric Requirements

Company Name: / Your Name:
Business Address: / City, State, Zip Code:
E-mail Address: / Primary Phone:
Signature:

Below, list ALL equipment and appliances that will require an electrical power source at Country Jam USA2016. These requirements MUST be provided in order to properly connect your equipment.

ApplianceQuantity AMPS Single Phase Only

  1. ______
  1. ______
  2. ______
  1. ______
  1. ______

Below, please note any special power requirements you may have. Special requirements may NOT be met due to circumstances.

Additional Information:

  • You MUST provide your own extension cords.
  • ONLY one (1) appliance may be plugged in per outlet

Country Jam USA will provide the following outlets for you to plug your equipment into. Please review your plug and the following outlets.

15 or 20 AMP Receptacle120 Volt 30 amp RV Receptacle 240 Volt 50 Amp RV Receptacle

Limited

PLEASE RETURN FORMS WITH SIGNED CONTRACT

Electrical Service Order Form

Payment MUST accompany order to receive advance order rate, NO EXCEPTIONS. A 10% charge will be added to all orders requested onsite. If your application is received after May 31st, 2018 you will be charged the event price (see table below).

Firm Name: / Primary Phone:
Address: / City, State, Zip Code:
Authorized by:
Signature:

Standard Electrical Service

  • 120 Volt 20 Amp A.C. single phase
  • 120 Volt 30 Amp A.C. single phase
  • 240 Volt 50 Amp A.C. single phase (Limited)

Electrical Power Requirements

QuantityTOTAL

110 volt 20 AMP circuit (basic/lights only)
$100 PER APR 30
$150 POST APR 30
120 volt 30 AMP circuit
$150 PER APR 30
$200 POST APR 30
220 volt 50 AMP circuit
$250 PER APR 30
$350 POST APR 30

NOTE: Vendors must provide their own extension cords (minimum 12 gauge). ONE APPLIANCE PER OUTLET.

Payment Method

Please write checks payable to Country Jam USA. If paying by credit card, please fill out the credit card authorization form below.

Credit Card Authorization Form

PLEASE COMPLETE THIS AUTHORIZATION FROM AND RETURN TO US.

All information will remain confidential.

Cardholder Name: ______

Billing Address: ______

______

Credit Card Number: ______

Expiration Date: ______

Card Identification Number (last 3 digits located on the back of the card):______

Amount to Charge: $ ______

I authorize ______to charge the agreed amount listed above to my credit card provided herein.

Cardholder – Print Name, Sign and date below:

Signed: ______

Date: ______

Name: ______

Once signed, return completed form to: or Country Jam USA1711 S. Hastings Way Eau Claire, WI 54701