Name of Applicant *

First Name

Last Name

Business Phone *

(###)

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Business Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Agreement to provide supplies *

All Vendors must supply an EZ- UP, tables, tablecloth, chairs, lights, electrical cord (Minimum 50ft) and a surge protector. Electricity will be provided and is included within the space fee.

I agree

Agreement to fees per event *

Spaces are 12x12 ft. If your booth will not fit you must purchase additional space. Each space is $20 per event. Upon completion of this form, follow the prompts to complete payment.

I agree

Dates Desired *

July 12th

July 19th

July 26th

August 2nd

August 9th

August 16th

August 23rd

Required information from vendors *

All business must have a City of Yucaipa Business License, and send the complete license form to: Food vendors must provide a copy of their permits to yucaipavalleywine@gmail.com.

I agree