I. List the name of the main contact person:
A. Please list the main contact's title:
B. Please list the main contact's telephone or pager number:

II. What is the name of the production:
A. Date of the event:
B. Time of the event (specify a.m.or p.m.):

III. Location of the production:

IV. Name of Pyrotechnic Operator:
A. Employed by:
B. Experience & Credentials:
C. Names of Assistants:
D. Contact Telephone Numbers:

V. Name of Insurance Carrier:
A. Name of Agent or Contact:
B. Telephone Number:
C. Liability Coverage or Limits:

VI. Material Safety Data Sheets:
1. Will you send in advance yes no
2. Available before show yes no

VII. Pyrotechnic Devices Used (Check all that apply & give amounts.):
Flash Potts Amount:
Gerbs Amount:
Puff Pots Amount:
Air Burst Charges Amount:
Concussion Amount:
Smoke Generator Amount:
Other Devices (Please list device and amount.)

VIII. Typical Composition of Materials To Be Used Include: