GROUP ELECTRICAL REQUEST FORM - NC Chapter, American ...
VENDOR SERVICES REQUEST FORM
GROUP: NC Chapter – American College of Surgeons ESM: Christine McCullough
VENDOR SET-UP DATE: Friday, July 19, 2019 @ 1:00 p.m. – 5:00 p.m.
VENDOR TEAR-DOWN DATE: Sunday, July 21, 2019 - after 10:45 a.m.
Location: Cardinal Ballroom
VENDOR NAME: BOOTH #:
|TYPE: |# NEEDED |CHARGES |
|TELEPHONE: | | |
|House Phone | |$75.00 |
|Outside Access Telephone | |$200.00 |
|DID Telephone | |$100.00 |
|HIGH SPEED INTERNET | |$250.00 |
|Hub or Wireless Router | |$50.00 additional to internet charge |
|LINES: | | |
|Fax | |$100.00 |
|PC | |$100.00 |
|ELECTRIC: | | |
|Standard 110 Volt Outlet | |$75.00 – one time charge |
| Standard 208 Volt Outlet | | |
|**20 Amp/1 Phase | |$75.00 |
|**20 Amp/3 Phase | |$75.00 |
|**30 Amp/1 Phase | |$75.00 |
|**30 Amp/3 Phase | |$75.00 |
|**50 Amp/1 Phase | |$75.00 |
|**50 Amp/3 Phase | |$75.00 |
|CORDS/CONNECTORS: | | |
|**25ft – 1 outlet extension cord | |$25.00 |
|**Multiple outlet strip | |$20.00 |
|Exhibition Company Hired: Yes No |
*Full payment must accompany this form or your order will not be processed. Services are not refundable for no-shows or unused items. Refunds will only be granted outside 14 days.
METHOD OF PAYMENT (CHECK WILL NOT BE ACCEPTED)
CREDIT CARD:
Card # Exp. Security Code
Cardholder Name:
Receipt to be sent to:
(Fax number or email address)
VENDOR COMPANY NAME:
Address:
Phone:
Authorized Signer: Date:
PINEHURST, LLC
Conference Services
ATTN: Ms. Jo Prentiss
Joann.prentiss@
80 Carolina Vista Phone: 910-235-8201
Village of Pinehurst, NC 28374 Fax: 910-255-3368
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