PEORIA CIVIC CENTER
Name of Event
Booth / Meeting Room #
Firm Name
Phone
Address
Fax
City
State
Zip
Authorized By
Date
Title

INTERNET SERVICE AVAILABLE Advance Fee** Floor Order Fee*** Qty. Total
1. High Speed - Wireless $ 25.00/day $ 50.00/day
2. High Speed -Up to three (3) IP addresses (per port) $ 125.00/3-day $ 175.00/3-day
3. High Speed- Up to three (3) additional IP addresses $ 50.00/day $100.00/day
      Grand Total
** Up to fourteen (14) days before event .
** Within thirteen (13) days before the event or on event day.
*** Linksys cards are not compatible with the Peoria Civic Center system.

Remit payment to:

Peoria Civic Center - Accounting Dept., 201 SW Jefferson, Peoria, IL 61602
Phone (309) 673-8900 Fax (309) 680-3585

METHODS OF PAYMENT CHECK / MONEY ORDER / CREDIT CARD (check one)
MasterCard AmericanExpress Discover Visa
Credit Card Number    
Expiration Date    
Name as it appears on card    
Due to a requirement by federal law, the exact name of the credit card holder and the address in which the bill for the credit card arrives at need to be used. If the information at the top of the form does not correspond with these requirements, please fill out the following:
Address Bill Arrives At: City, ST, ZIP:

CONDITlONS AND SAFETY REGULATION:

  1. All equipment, regardless of source of power, must comply with all federal, state and local safety codes.
  2. "House electricians" must perform all internet work. Special equipment requiring company engineers or technicians for assembly, servicing preparatory work and operation, may not be executed without "house electrician ".
  3. All materials and equipment funished by the Civic Center personnel for this service order shall remain the Civic Center property and shall be removed ONLY by the Civic Center personnel at the close of the show.
  4. Rates do not include connecting equipment or special wiring. Labor for additional electrical work will be charged in one-half hour increments at $50.00 per hour. Special materials required will be charged at cost, plus 20%
  5. Conference software configuration available at one-half hour increments at $50.00 per hour
  6. No booth will be allowed to open until ALL HOUSE CHARGES ARE PAID.
  7. Peoria Civic Center personnel will install, maintain, inspect and remove all phone services.
  8. High Speed Connection 10/100 Ethernet card. DHCP protocals required

The parties agree that the implied warranties of merchantahility and fitness for panicular purpose and all other warranties express or implied, are excluded from this agreement. Peoria Civic Center Authority does not assume any liability for damages of any type whatsoever or loss of anticipatory profits resulting form the use of equipment or services or delivery or installation, or damage of any sort whatsoever to user's goods or equipment arising from any cause whatsoever For additional copies please contact the Peoria Civic Center or refer to our web site at www PeoriaCivicCenter.com
*ALL PRICES SUBJECT TO CHANGE WITHOUT NOTICE

Press the submit button to send this form electronically.
or
Press the reset button to clear all form fields
or
Print out this page and remit this form via USPS.