Main Contact Name *

First Name

Last Name

Main Contact Phone *

(###)

###

####

Mailing Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Physical Address (If Different)

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

You are a(n) *

Individual

Family

LLC

Partnership

Corporation

How frequently would you like to attend the market? *

Weekly

Bi-Weekly

Monthly

Other - Please Explain

Other Required Licenses & Insurance *

All vendors are responsible for knowing and acquiring all necessary licenses. Please indicate which licenses you are required to have. Check all that apply. Please email copies to brookhavenfarmersmarket@gmail.com. *Your documents must be received in order for you to be considered.*

Department of Agriculture

Department of Health

Candlers License

Liability Insurance naming Brookhaven Farmers Market as additional insured (applied to all)

Other

Are the products handmade? *

Yes

No

Please indicate you are aware of the following: $50 non-refundable application fee, weekly fees are due at the Market, payable via cash or check and collected on-site by the Market Manager. Vendors are required to maintain liability insurance, provide proof of insurance, copies of certificates or licenses. Vendors will be required to provide their own 10x10 tent, table, and tent weights. *

Yes