Please Choose One:

Interested in Flat Rate Event or Charged Admission Carnival?:
Do you have a budget for Flat Rate Event? If so, what amount?:
Event name :
Brief description of event:

Exact physical address of event location:

Approximate Dimensions of Available Space:

Proposed dates for event:

Proposed hours for event:

Name of sponsor, organization, corporation, etc.:

# of years event has been operating:

Do you currently charge Gate Admission?

# of children's rides requested

# of adult rides requested

Most recent amusement ride supplier:

# of rides supplied by most recent amusement ride supplier

Most recent amusement ride gross:

Most recent gross attendence:

Contact name:

Contact phone:

Contact email:

Contact address:

Required Fields: Please fill out all fields

This information is for our company use only and is not shared.

Cole Amusement Company, Inc. 5311 Indian Draft Rd Covington, VA 24426 Office: 540-965-4553 Fax: 540-969-0170