1333 Bayshore HighwayBurlingame, CA94010
Ph: 650-696-3040 Fax: 650-342-0652
Email:

EXHIBITORSERVICES ORDER FORM

ORDERING: To order audio-visual-electrical services for your booth, please fill out this form and return a copy with your payment to the address above at least 7 business days prior to the Conference start date. An additional 20% will be added for orders received after this date.

PRICES: Labor is a one time charge unless the order is extensive. Equipment is charged per day. NOhalf day rentals. On-site cancellations will be 100% of the rental charges. Credit card payments over $4000.00 will charged 3.75% fee on the amount over $4000.00.

DELIVERY: Your on-site contact must be present to sign for receipt of your order. For security reasons, we strongly recommend that installation be scheduled as late as possible during set-up.

EXHIBITOR INFORMATIONON-SITE INFORMATION

Firm Name: / On site Contact:
Address: / Booth #: / Show Name:
City: / State: / Zip: / Delivery Date: / Time:
Ordered By: / Phone: / Opening Date: / Time:
Signature: / Fax: / Removal Date: / Time:

Email (Required):

DESCRIPTION / QTY / DAY
RATE / # OF DAYS / DESCRIPTION / QTY / DAY RATE / # OF DAYS
PC LAPTOPS / PRINTERS / PERIPHERALS / ELECTRICAL SERVICES
PC Laptop w/ DVD-CDRW-MS Office / $400.00 / 120 Volt / Single Phase – Single Outlet Service / $50.00
Black and White Printer / $250.00 / 120 Volt / Single Phase – 15 AMP Service / $175.00
Wireless Mouse (Slide Advancer) / $50.00 / 120 Volt / Single Phase – 20 AMP Service / $215.00
VIDEO EQUIPMENT / 208 Volt / Single Phase – 30 AMP Service / $275.00
VHS Videocassette Player / $50.00
DVD Player / $50.00 / 208 Volt / Three Phase – 60 AMP Service / $500.00
208 Volt / Three Phase – 100 AMP Service / $650.00
DATA DISPLAYS / 208 Volt / Three Phase – 200 AMP Service / $800.00
20” Flatscreen Tabletop Monitor / $250.00
40” Flatscreen Monitor on Floor Stand / $475.00
46” Flatscreen Monitor on Floor Stand / $550.00 / ELECTRICAL PERIPHERALS
15’ – 50’ AC Cable / $15.00
100’ AC Cable / $20.00
AUDIO EQUIPMENT / Additional Power Strip (Rated at 15 AMPS) / $10.00
Wireless Microphone (Hand Held or Lav) / $150.00
Wired Floor Microphone / $60.00
4 Ch Mixer (Required for Microphones) / $55.00
Powered Speaker (Required for Microphones) / $120.00
Laptop Audio Interface Package / $115.00
PLEASE CALL FOR PRICING ON EQUIPMENT NOT LISTED ABOVE
**PAYMENT INFORMATION**PLEASE SEE CREDIT CARD AUTHORIZATION FORM** / Equipment Total
Check Enclosed: / Payable to VISUAL AIDS ELECTRONICS / 22% Service Charge:
VISA / MASTERCARD / AMEX / TAX (9%):
Cardholders Name: (PRINT) / On-Site Orders add 20%:
Phone Number: / 3.75% Additional (if applies):
TOTAL AMOUNT DUE:
Authorized Signature:
The undersigned acknowledges receipt of the equipment described herein and agrees to assume the replacement cost for any loss or damage of said equipment which is the property of Visual Aids Electronics Corporation.
Received by: / Date:

Updated 4/1/2013

CREDIT CARD AUTHORIZATION

I hereby certify that I am the Cardholder or authorized user with signature rights and I acknowledge receipt of goods and/or services from VAE in the amount of the TOTAL shown hereon and agree to perform the obligations set forth in the Cardmember’s agreement with the Issuer.

Card User’s Name:Signature:Date of Charge:

Credit Card Number:

CARD VERIFICATION VALUE CODE:

(the last 3 or 4 digits AFTER the credit card number in the signature area on back of card)

Cardmember’s Name:

(As it appears on the card)

Company Name:

(As it appears on the card)

Exp. Date:Type of Charge:

(Mastercard, Visa or American Express)

Street Address:

City:State/Province:

Zip Code:Country:

Phone Number:Fax Number:

Charge Amount:Approval code:

Reference Information:

Salesperson: Dept. Number: 320506

Description of Charge: AV Rental

(Invoice Number Required)

Visual Aids Electronics Corp.

1333 Bayshore Highway, Burlingame Ca. 94010

650-342-0652

NOTE: YOUR CREDIT CARD STATEMENT WILL SHOW THIS CHARGE AS:

“VISUAL AIDS ELECTRONICS, GERMANTOWN MD”