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The Tenth Annual - Healthcare Design Magazine

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Audio Visual Request Form<br />

ORDERING: To order audio visual equipment for your booth, fill out the necessary information and return to Southwest Audiovisual, 1734 N. 22nd Ave, Phoenix, AZ 85009.<br />

You will receive notification confirming your order within two business days. If you do not receive notification of receipt, please call our office.<br />

PRICING:<br />

PAYMENT:<br />

Orders must be received 14 days in advance of show date to insure availability.<br />

Prices are based on a "per day" usage with a 2 day maximum charge up to 5 days. Setup days with NO equipment usage will NOT be charged!<br />

<strong>The</strong>re is a $90.00 service fee which includes the delivery and pick-up of equipment. Any additional labor required must be specified in advance and will be quoted accordingly.<br />

All orders must have 100% of estimated charges plus sales tax remitted with order. We accept checks, Visa, Mastercard, or American Express for payment.<br />

CANCELLATIONS:<br />

Cancellation of equipment ordered must be received 48 hours prior to delivery date to avoid charges. If services have already been provided at the time of<br />

cancellation, 50% of original charges will be applied with a minimum charge of one full day.<br />

Name Phone Show Name<br />

CO Fax Show Site<br />

<strong>Healthcare</strong> <strong>Design</strong> Conference,<br />

<strong>The</strong> <strong>Tenth</strong> <strong>Annual</strong><br />

Phoenix Convention Center North<br />

Building Halls A-E<br />

Address<br />

Show Dates<br />

November 3-6, 2012<br />

City State Zip On Site Contact<br />

Email Booth # Contact's Cell #<br />

VIDEO MONITORS ( IF MOUNTING, PLEASE CALL WITH SPECS FOR PRICING! )<br />

20" LCD (for computer use only!) $55.00<br />

32" LCD $195.00<br />

42" PLASMA ON FEET W/COBRA STAND (check one) $395.00<br />

50" PLASMA ON FEET W/COBRA STAND (check one) $495.00<br />

VIDEO PLAYERS<br />

STANDARD DVD $25.00<br />

BLU-RAY DVD $95.00<br />

DATA PROJECTORS<br />

1000 LUMENS $125.00<br />

2300 LUMENS $250.00<br />

SCREENS & ACCESSORIES<br />

6 FT. TRIPOD W/SKIRT $25.00<br />

8 FT. TRIPOD W/SKIRT $35.00<br />

CART W/SKIRT 34" 44" 54" (check one) $30.00<br />

AUDIO<br />

P.A. SYSTEM (1 SPEAKER) W/WIRED MIC. Lavalier Hand Held (check one) $55.00<br />

P.A. SYSTEM (2 SPEAKER) W/WIRED MIC. Lavalier Hand Held (check one) $95.00<br />

WIRELESS MIC. (USE W/SYSTEMS ABOVE) Lavalier Hand Held (check one) $95.00<br />

CD PLAYER (USE W/SYSTEMS ABOVE) $25.00<br />

Price Quantity Total Cost<br />

PLEASE NOTE: This form is only a partial list of equipment featuring commonly requested items. We stock a full<br />

line of audio and video equipment. For items not found above, please inquire about availability and prices.<br />

Sub Total $<br />

Visa MasterCard American Express # Show Days (2 Day Max) x<br />

Credit Card Number<br />

Card Address (if different then above)<br />

Card Code<br />

Equipment Total =$<br />

9.3% Sales Tax +$<br />

Delivery/PU + $90.00<br />

Additional Labor +$<br />

X TOTAL AMOUNT DUE $<br />

Signature<br />

By purchasing services from Southwest Audio Visual, Inc., customer agrees to all<br />

Terms and Conditions of Service Agreement. (See reverse side)<br />

Expiration<br />

www.swav.net - Office (602) 258-4911 - Toll-Free (800) 266-SWAV - Fax (602) 254-4226<br />

1734 N. 22nd Avenue Phoenix, AZ 85009 BREDE 0109

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