Please mail this form with your deposit to:

 VENDOR INFORMATION

Business Name _______________________________ Contact Name _________________________

Street Address ________________________________ City____________ State ____ Zip _______

Phone _____________ E-mail _________________________ Web Site ______________________

Signature __________________________________

INSURANCE INFORMATION

Insurance Company ______________________________ Phone Number ______________________

Policy Holder ______________________ Policy Number __________________________________

Liability Coverage Minimum ________________________ Confirmation Date ___________________

Items to be sold – ( No food or beverages )

______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

The Posse Grounds will be available for set-up at 7 am on October 21, 2006.

The run leaves Jamestown Harley at noon.

A $25 non-refundable deposit and proof of insurance is required by September 30, 2006.

We will accept money orders, cashier, business or personal checks for your deposit.

Booth spaces are approximately 10’ x 10’

The balance of $25 is due by 11 am on October 21, 2006.

We will accept money orders or cash ONLY on the day of the run.

Insurance Confirmed _______
Deposit Received ______ MO# _______  Check # _______
Paid In Full  MO# ______  Check # _______

 Revised 9-06