1. You

Name:
Phone:
Email:
Address:
City:
State:	AA AE AK AL AP AR AZ CA CO CT DC DE FL GA HI IA ID IL IN KS KY LA MA MD ME MI MN MO MS MT NC ND NE NH NJ NM NV NY OH OK OR PA RI SC SD TN TX UT VA VT WA WI WV WY
Zip:

2. Event

Date:
Start time:
Location:

3. Budget

Approximate budget allocated for music:

4. Music Style
Check the style(s) of music you require. Check as many as apply.

Jazz/Swing/Big Band	50s
Motown/Soul/60s	Disco/70s
Classic R&B	Classic Rock
Contemporary Dance (Club Music)
Not sure (see songlists for ideas)	Other

If you are not sure what style(s) you require, indicate the age breakdown of your affair. Enter # of guests next to each group.

Under 20		Ages 20 to 30
Ages 30 to 40		Ages 40 to 50
Ages 50 to 60		Ages 60 to 70+

5. Information Preference
Please check your preference(s). Check as many as apply.

Will your decision to purchase be based on a live performance?

Will your decision be based on a tape or CD?

Would you prefer to have a promo package sent to you?

Or would you prefer to arrange for an in-home appointment with our representative?

6. Questions & Comments
Type any short questions or comments in the box below.