Farmers' Market Application 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?*What county are you located in?*DelawareFranklinKnoxLickingMadisonMarionMorrowUnionOtherFarmers' Market FeesThere is a one-time, non-refundable application fee of $10 for the Main Street Delaware Farmers' Market. Please note that this does NOT guarantee a space for your farm at the market. Your application will be reviewed by our team. If accepted, you will receive a separate request for payment. 2019 fees for farms in Delaware County or contiguous counties: Full Season (23 weeks, Wed & Sat) — $220.00 Single Week — $20.00 2019 fees for farms OUTSIDE OF Delaware County or contiguous counties: Full Season (23 weeks, Wed & Sat) — $300.00 Single Week — $30.00 Application Fee* Price: $10.00 Credit Card American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20192020202120222023202420252026202720282029203020312032203320342035203620372038 Expiration Date Security Code Cardholder Name Total $0.00 I am aware that there is a one-time registration fee of $10.00 for Farmers' Market vendors, and acknowledge I will receive a separate email invoice to make this one-time payment after my application has been received.* I understand. I understand that Main Street Delaware requires all vendors to have insurance with no less than 300k in liability coverage. In order to participate in any Farmers' Market event a Certificate of Insurance is required to be on file. I attest that I will add Main Street Delaware 20 E. Winter St Delaware OH 43015 as an additional interest on our insurance and can provide documentation upon acceptance into the market.* I understand and will provide a Certificate of Insurance. 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.