Lehighton Bike Night
Application for Vendor Space

(Please check one)
Vendor Classification		  RETAIL GOODS  FOOD PRODUCTS  NON-PROFIT  Optional Electric
By June 30, 2010   ____ $55.00   ____ $125.00   ____ $45.00 Please check only if you require electrical power for your vendor operation. There is no extra charge.
After June 30, 2010   ____ $75.00   ____ $150.00   ____ $60.00

Vendor space fees: _____ vendor space(s) at $_____________ per space = $___________
Make check or money order out to "Lehighton Bike Night"

My vendor spaces(s) will offer the following products, merchandise, or services: (use reverse for more space)

____________________________________________________________________________________
This information must be provided. Applications without this information will be returned without action.

By my signature below, I agree that I have read and understand the Lehighton Bike Night Vendor Agreement and accept all conditions thereof:

For the "Vendor":
(Name) ____________________ (Signature) ________________________ (Date) ___ /___ / 10

Business Name: ________________________________________________________________

Address: ______________________________________________________________________

City: _________________________________________ State: _____ Zip: _______________

Phone: ( ____ ) ____ - _____ Email Address: ________________________________________

Company/Organization Web: http://www._______________________________________________

Please mail two (2) copies of this application, a copy of proof of liability insurance and PA State Food Employee Certification (Commercial Food Vendors only), along with your check or money order to:
Bud and Louise Stofik
c/o The Bike Shop
101 N. 1st Street
Lehighton, PA 18235
--------------- Do Not Write Below This Space ---------------

Vendor Space(s) Assigned: _______________

Signature: _____________________________________________ Date: ____ / ____ / 10.
Lehighton Bike Night Representative
Vendor Levels  -  Vendor Contract