Name:

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Date of Event:

Month January February March April May June July August September October November December

Day 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31

Year 2011 2012

Check the items that you are interested in:

Inflatable Rides

Games

Concessions

Mechanical Rides

Animals

Tents/Tables/Chairs

Other(explain below)

Have you ever rented from us in the past?

Metz Amusements

Yes

No

How did you find us?

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