Near site information:  Our system is a Polycom 512 system with a 32" receiver.  Contact is Sherry or Bonnie

at 251.476.0685. 

Direct  room telephone number is 251.471.2266 (to be used only during conference).  ISDN dial up number

is 251.602.5612

 Would you prefer our site to initiate the call?  Yes    No   (Circle one)

Please tell us in advance of any special requirements.  Indicate Special Requirements: e.g. videotape, document camera, laptop connection, catering, et cetera.

(Call Barlow & Associates for pricing.) 

Projected Cost: Costs are pro-rated based on information provided by scheduling party and are subject to change

based on changes made prior to or at the time of the conference.

Room Rental Rate: ___________  ISDN Tel. Fees:   ______________  Other : ______________

TERMS AND CONDITIONS:  1.  Reservation of rented room will not be held until signed reservation form is

received.  2.  Reservation fees may be applicable at some rented locations.  If applicable reservation fee payment

must accompany signed reservation form.  3.  Room rentals and ISDN long distance fees are based on hourly

fees, minimum one hour and billed in half-hour increments thereafter. 4. Room rental may not be reduced by

unused time and additional use beyond the scheduled time may be restricted.  5.  Cancellation fees – loss of

reservation fee if cancelled four or more days prior to conference; 50% of room rental will be assessed if cancelled

two days prior to conference; 100% of room rental if cancelled within 24 hours of conference.  6. Payment terms are

NET 10 days following conference date.   7.  Barlow & Associates and its affiliated rental sites are not

responsible for delays, postponements, failure of video conferencing technology or cancellations due to

unforeseen circumstances and in no way are liable for any loss of use, lost profits, consequential or any other

damages. In no event shall any liability exceed the amount of the room rental fee.

 Name Authorizing Payment:

 Date:

 Signature:

Call to book room, then fax this form with signature to (251) 471-2266 or e-mail to barlowreporting@bellsouth.net.

 We  accept Visa, MasterCard, American Express, and Discover.  Call for information.