Vendor Application Form For Chip Off The Block

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Vendor Application form for Chip Off The Block – Pottsville, PA
Vendor/Business Name
_________________________________________
PA Sales Tax ID (required)
_________________________________________
Mailing Address
_________________________________________
_________________________________________
_________________________________________
Type of art/craft (required)
_________________________________________
Contact Name: ________________________________________________
Phone Numbers: ________________________________________________
Email Addresses: ________________________________________________
Number of table spaces needed ($25 each) _______ (Tables will be provided for vendors)
Please either include 3 photographs of your booth/tent and merchandise for review or a link to your
website: ________________________________________________
By applying for the Chip Off The Block, the applicant releases Schuylkill County's VISION, its
affiliates and strategic partners, including the Block of Art, involved with the show from any and all
liabilities or thefts that may occur. Vendor is required to provide their own insurance. All items being
sold must be made in the USA and handcrafted by the artisan/craftsman represented by the booth.
Vendors that do not adhere to these requirements may be asked to remove the items or leave.
Applicant Signature __________________________________________________
(signature verifies that the vendor has read and agrees to the above statements)
Please mail this form and your check to:
Schuylkill Vision
1464B Route 61 South
Pottsville, PA 17901

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