Please keep me updated
about the availability of
SEGWAYS ON CAMPUS
INFORMATION 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


School


Position/Title


Mailing Address (Include Suite #)


City


State


Zip Code


Office Phone


Fax




Email Address


Web Site Address


How Did You Come To Find Us?


Referals' Name or Source

Possible Campus Dates/Events


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.




© 1994 - 2005 A Coyote Production, Inc.™
Box 772111, Orlando, Florida 32877-2111
Voice: 407.854.0606 Fax: 407.854.0607