Big Top Tent Display Space(s):
(10' x 10' on asphalt)

Number of Units	Price
1	$350
2	$650
3	$850
4	$1,050
Add $150 for each unit over 4 units
Enter number of units:

Outdoor Display Space: (on asphalt)

Please complete this form.

Total cost for Outdoor Display Space: $

Other Services:

We will require electricity ($25 per 20 amp circuit; 2400 watts max) circuit(s)

We will require forklift services ($60 per hour. $25 mininum) minutes (in multiples of 15)

You will be invoiced for the following amount: $

Make Checks Payable to: Joplin Truckers Jamboree

Company Information

Company Name
Product/Service to be Displayed
Contact Name
Address
City
State	-- Select -- AB AK AL AR AZ BC CA CO CT DE DC FL GA HI IA ID IL IN KS KY LA MA MB MD ME MI MN MO MS MT NB NC ND NE NF NH NJ NM NS NT NU NV NY OH OK ON OR PA PE QC RI SC SD SK TN TX UT VA VT WA WI WV WY YT
Zip
Phone
Fax
Email

On behalf of the company that I represent, I (we) assume full legal, financial and insurable responsibility for any products, trucks, and equipment. I (we) fully release the JOPLIN TRUCKERS JAMBOREE and those associated with it from any and all liability.

Authorized Signature (type name)
Title
Date
	This helps to prevent automated submissions.
Enter Code: