Billy Rock Entertainment

Reservation Intake Form

Template version of your production booking detail capture, then handoff to secure payment.

Confirmed Entertainer Choice(s)

Details	Value
Entertainer 1 Confirmed Choice	Pending selection
Entertainer 2 Confirmed Choice	N/A
Total Price	$0
Down Payment Due Today	$0
Cash Balance on Arrival	$0
Quote / Record ID	N/A

Please fill out all final details below before secure payment. Handoff URL: https://payments.billyrockentertainment.com/?recordid=draft_record

First Name *Last Name *

Email *Phone *

Backup Contact NameBackup Contact Phone

Country *Service Address Line 1 *Service Address Line 2 (Apt/Suite)

Service Address City *Service Address State *Service Address ZIP Code *

Party Occasion *Guest of Honor's Name *

Notes & Requests

Estimated Male Guests Attending *Estimated Female Guests Attending *

Yes, we need entertainers to perform on same-sex genders.

Example: for a bachelorette party with gay male guests, check this for equal attention.

I agree to opt-in for SMS & Email messages.I agree to Terms & Conditions.