GOP Pay & Sign

1
Name
First Name
Last Name
2
Email
example@example.com
3
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
4
Phone Number
Please enter a valid phone number.
5
Date of Event Please select the date you are requesting
Date
Year
Month
Day
6
TimeWhat time is the Event going to start?
1
2
3
4
5
6
7
8
9
10
11
12
Hour
00
01
02
03
04
05
06
07
08
09
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
Minutes
AM
AM
PM
7
What type of Glowout Party are we hosting?Please Choose from the Following
Basic Tent Party
Karaoke Party
Paint Party
Gaming Party
Dance Party
Other
8
Please Select All Add-ons that you are requesting
Disco Lights
Black Lighting
Karaoke Speaker with 2 Mics
Projector
Projector Screen
Inflatable Couch (1)
Inflatable Couch (2)
LED Lights
Tarp Flooring
No Flooring
Table & Chairs (2 Tables 10 Chairs)
1 Table 5 Chairs
Other
9
Please describe your entrance path and where you would like your event to be set up
Huge
Large
Normal
Small
Ok
Ok
10
SignatureBy signing you agree to the following: * Instructions and checklist will be text and emailed 24 hours prior to event * Please make sure there is easy access to setup & pickup the tent & equipment * Do NOT breakdown items - We do all the work for you. *Liability waiver & Checklist will need to be signed upon arrival **COPY OF ID AND CREDIT CARD to hold on file ONLY is required upon delivery** * Any damages or lost items are subject to additional charges or fees. ABSOLUTELY NO SMOKING - SHARP OBJECTS - LAYING OR PRESSING AGAINST the tent or inflatable items Must give 48hour notice of cancelation in order to receive full deposit return
Powered by Jotform SignClear
11
Thank you for your request! In order to reserve your spot a 75$ Deposit is required. We accept Paypal or Venmo. An Invoice will be sent to your email with a link for payment.By signing (Typing your Full name and INITIAL)you agree to the following: * Instructions and checklist will be text and emailed 24 hours prior to event * Please make sure there is easy access to setup & pickup the tent & equipment * Do NOT breakdown items - We do all the work for you. *Liability waiver & Checklist will need to be signed upon arrival **COPY OF ID AND CREDIT CARD to hold on file ONLY is required upon delivery** * Any damages or lost items are subject to additional charges or fees. ABSOLUTELY NO SMOKING - SHARP OBJECTS - LAYING OR PRESSING AGAINST the tent or inflatable items Must give 48hour notice of cancelation in order to receive full deposit return
Should be Empty: