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 17

June 24

July 1

July 8

July 15

July 22

July 29

August 5

August 12

August 19

August 26

September 9

September 16

September 23

September 30

October 7

October 14

Payments Accepted *

Check all that apply

Credit/Debit

Cash

Venmo, Cash App, or Similar

Which of the following do you accept? *

SNAP/EBT

HIP

SNFMP

WIC

None of the above

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

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

Date *

MM

DD

YYYY