Vendor Contract – Worcester Mineral Club

Name of Business

Email

Mass Tax ID Number

Attach Copy

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Name

First

Last

Address

Address Line 1

Address Line 2

City

State

Zip Code

Cell Number

Please link to your website or any social media you use for your business

Emergency Contact Name

Emergency Contact Cell Number

Medical Issues (optional)

Personnel Assisting at Booth

Vehicle Make and Model or Trailer Length

Dealer Signature

Clear Signature

business of or

Date

Large Vendor Booth

Price: $450.00

Three 8 foot tables and two 6 foot tables.

PayPal Commerce

Card Number

Expiration Date

Security Code

Card Holder Name