MSS Vendor Application and Map by lSU30ve4


                                                Vendor Information        [hit TAB to move to next field]
Company Name (specify business type if applicable) :
Owner’s Name:                                           Select a User ID:              Password:
Current Address [home business other -specify:                ]:
City:                                                   State:                 ZIP:
Phone 1:                                      Mobile 1:                             Fax:
Phone 2:                                      Other (specify):                      Email:
Website:                                      Other (specify):                      Email 2:
                                               Business Information
What tag line would you like to use for your business (catchy summary of what you sell)?:

     What do you sell, comment if desired:
  Produce                                                        Arts
     Certified Organic                                           Crafts
     No-spray                                                    Service
     Hydroponic                                                  Information
  Meat                                                           Collectable
  Cheese                                                         Import
  Bakery                                                         Antique
  Prepared Food                                                  Furnishings
  Food Cart                                                      Misc. – Non-food
  Misc. Food                                                     Other

                                             Space Rental Preferences
Vendor Space # (provide alternates, in order of preference):
                                                st                        nd
Start Date:                            Time: 1 Half-Day                  2 Half            Entire Day:
                           st                         nd
        Times: Mon – Sat: 1 half: 8:00am to 1:00pm / 2 half: 2:00pm to 8:00pm // Sunday: (Half Day) Noon – 5:00pm
Number of consecutive rental days:                       Check if applying for “Treasure Hunt” Sundays:
Please Check if Monthly Rental Desired:                  If Monthly: Consecutive Months (estimate):
Rental Fee – Half Day:                   Rental Fee – Full Day:                Rental Fee – Monthly:
  A: $8                                    A: $12                                A: $99
  B or Alley: $10                          B or Alley: $15                       B or Alley: $125
  B+: $12                                  B+: $18                               B+: $150
  C: $15                                   C: $22                                C: $199
  D: $25                                   D: $35                                D: $250
                                           Food: $40                             Food: $290
Total Rental Fee: [Multiply Rental Fee x Duration]            $          makes checks payable to Main Street Station
Print Name:
By checking this box I am stating that I have read and agree to the Main Street Station Guidelines, and have
reviewed the above information and attest to its accuracy          [this is your electronic signature]
Signature of Applicant (if handwriting form):                                            Date:
  Please save a copy of this form and e-mail or mail back                          Market Address:
                                                                                Main Street Station
                   Contact the market:
                                                                               215 South Main Street
             608-637-1912 - Market Office
                                                                                Viroqua, WI 54665
             608-606-0159 - Manager Cell


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