Processor Food Artisan Farmer Application Form

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OFFICE USE ONLY
Interview Date:_______________
Last Review:_________________
Approved:
Y
N
Approved by:________________
UBI # Verified
Y
N
Spring Vendor
2015 PMSA Market Participant
Yes
No
Application Processing Fee** ($35.00) _____initial (non-refundable) must be paid when application submitted.
PLEASE USE PRINT AND WRITE CLEARLY:
Contact Name(s) _____________________________________________________________________________
Company Name __________________________________________________________________
UBI# (required) _________________________________________
Address ___________________________________ City ___________________, WA Zip_______________
Best phone number (_____) _____ _________
Email address ____________________________________________Fax (_____) _____ ________________
Describe products to be sold at the Market:
____________________________________________________________________________________
PAYMENT INFORMATION
Processor 
Food 
Artisan Farmer
Applying For:
Office
Use Only
Date
% for daily sales
Received
/ Initial
Electricity Fee
# seasons __________ x $30 =
$ 30
#spaces _______ x Rental Fee (see chart) =
$109
Farmer
(5%)
Space Rental
$109
#spaces _______ x Rental Fee (see chart) =
Processor
(6%)
Space Rental
$109
#spaces _______ x Rental Fee (see chart) =
Artisan
(8%)
Space Rental
$109
#spaces _______ x Rental Fee (see chart) =
Food
(10%) Space Rental
Application Fee
$35

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