On-Line Request

Please create and send me a
PERSONALIZED ON-LINE ORDER FORM
based on the following information.

ON-LINE ORDER REQUEST
Warning! Do Not use your RETURN key while filling out this form
(this will automatically Submit before you are ready).
You may use your TAB key.

Name (Required)

Email Address (Required)

Company/Organization/School (if applicable)

Position/Title

Mailing Address (Include Suite #)

City

State

Zip Code

Office Phone

Cell Phone

Fax

Web Site Address

If Other, Please Describe Your Business

How Did You Come To Find Us?

Referals' Name or Source

Other Things You Should Know About Me

Please BOOK This Date

I Just Need A QUOTE

Please Put A HOLD On This Date

Please CHECK AVAILABILITY For This Date

Please UPDATE This Event

Requested Service(s)
(Check All Appropriate Boxes)

DIGITAL SNAPSHOTS

4" x 6" Prints w/Frames

5" x 7" Prints w/Frames

Key Chains - 2" x 3"

Big Chair Photos - 4" x 6"

Bookmarks - 2.5" x 7"

Buttons - 3"

Magazine Covers - 4" x 6"

Magnets - 2" x 3"

Mouse Pads - 4" x 6"

Mouse Pads - 5" x 7"

Old Time Photos - 4" x 6"

Postcards2Home - 4" x 6"

Snow Globes - 2" x 3"

Super Hero Photos - 4" x 6"

Digital Snapshots - Other (See Special Instructions)

OTHER NOVELTIES

Become-an Idol Talent Show

Campus Nail Art

College Confessionals

Critters On Campus w/Outfits

Critters On Campus w/Custom Ts

Make-Your-Own Music DVD

Mobile CD Recording Booth

Mobile CD Booth w/Photo Cover

PopNoggins

Segways On Campus

Video Postcards2Home

Disc Jockey

Karaoke

Other (Describe in Special Instructions)

My Client/Event Information

(For multiple Dates, Times and/or Venues,
please fill out separate Order Requests.)

Event Client/Company

Contact

Event Date (Sample: January 4, 2004)

Event Theme:
(If you don't find yours here, describe in Special Instructions)

Start Time

End Time

Group Size
people are expected to attend.

Please note that we recommend larger sound systems and/or
multiple product stations for groups larger than 250.

Our Event Will Be Held At The Following Venue

In The Following Location At This Venue

The Venue Street Address Is

In The Following City & State

The Contact and/or Venue Phone Number Is

Special Requests and Instructions

DISCLAMER

FILLING OUT THIS FORM DOES NOT GUARANTEE OUR PRODUCTS
AND/OR SERVICES FOR YOUR REQUESTED DATE AND TIME.

YOU MUST RECEIVE AN EVENT CONFIRMATION FROM
A COYOTE PRODUCTION, INC.™
VIA FAX OR EMAIL TO ENSURE REQUESTED SERVICES.
PLEASE CALL IF YOU HAVE ANY QUESTIONS!

A COYOTE PRODUCTION, INC.™ and it's employees will not accept any
liability for products and services at events for which we have not received
a signed Event Confirmation from the responsible client.

Please Note: All artwork must be approved by the Event Client
at least 7 business days prior to the scheduled event date.