Form

Laconia Farmers' Market Vendor Application
Michelle Descoteaux

laconiafarmersmarket@yahoo.com

www.laconiafarmersmarket.com
Submission Date
/ Month / Day Year
at
: Hour Minutes
Contact Name
First Name Last Name
Business Name

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number
- Area Code Phone Number
Cell Phone
- Area Code Phone Number
E-mail
Website
Facebook Page

Yes No
Do you give the Laconia Farmers' Market permission to release your name, address, phone number, email, and website for marketing purposes or customer contacts

Yes No
Primary Vendor Category

Agricultural Prepared Food Crafter Artisan
Products for Sale
Do You Carry Product Liability Insurance?

Yes No
Should be Empty: