Please complete the application below. Name* First Last Farm Name*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Website What forms of payment do you accept?* Select All Cash Check Credit Card Which days will you participate at the Main Street Market? Select All Wednesday Saturday How did you hear about us?*Returning vendorMarket mailingWebsiteMarket staffReferred by another vendorOtherWill you be accepting senior vouchers?*YesNoWho should the check for senior vouchers be made payable to?*Will you be accepting SNAP?*YesNoWhat will you sell at the market?*Can you provide proof of insurance?*YesNoHow many weeks would you like to purchase?*Full Season ($210.00)1 Week ($15.00)Total $0.00 Credit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20182019202020212022202320242025202620272028202920302031203220332034203520362037 Expiration Date Security Code Cardholder Name By submitting this form, I agree to release Main Street Delaware, Inc., its agents, officers, volunteers and the City of Delaware, its agents, employees, officers and volunteers from any and all claims of any kind resulting in participation in the Main Street Famers’ Market.* I understand. PhoneThis field is for validation purposes and should be left unchanged.