Name *

First Name

Last Name

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone *

(###)

###

####

Which of the following dates are you available? *

Select all that you will be able to attend/staff for the duration of the market hours (3pm - 7)

June 16

June 23

June 30

July 7

July 14

July 21

July 28

August 4

August 11

August 18

August 25

September 8

September 15

September 22

September 29

October 6

Winter Market interest *

Would you be interested in participating in a Billerica Farmers Market - indoor winter market?

Yes

No

Maybe

Payments Accepted *

Check all that apply

Credit/Debit

Cash

Venmo, Cash App, or Similar

Which of the following do you accept? *

EBT

SNAP

WIC

HIP

SFMNP

None of the above

Please select the box below to indicate your understanding and agreement of the following fees: *

Late Cancellation (after 6pm Sunday): $30.00 No Show/No Call: $50.00

Yes, I agree

I have received (available above) and read the Billerica Community Farmers Market Policies and Rules and agree to abide by them. It is the responsibility of the owner of the business to advise the employees of all rules and regulations, and expected behavior. To the best of my knowledge, all information presented in this application is accurate and truthful. Falsification of information may lead to revocation of being a vendor. Failure to complete any section and include necessary documentation via mail may lead to non-acceptance. Vendor status is non-transferable and may be revoked for violation of the market rules. By signing this application, you affirm that you are an authorized representative of the applicant and that you and your company agree to adhere to all market rules and procedures. *

Yes, I agree

Date *

MM

DD

YYYY