Vendor Application Form Step 1 of 3 33% Name* First Last Business Name* Website Email* PhoneAddress* 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 Emergency Contact* First Last Emergency Contact Phone*Applying for:* Saturday Market Seasonal: $250 due in full ($375 for two stalls) Wednesday Market Seasonal: $110 due in full ($165 for two stalls) Both Sat/Wed Seasonal: $325 due in full ($500 for two stalls) Daily vendor: $8 for Wednesday/$13 for Saturday due each market attended If you will not be at the market every week, please provide a general idea of the dates you will attend:*Please list dates from May-OctoberCheck off which categories (and if organic) you will bring to the market: Vegetable Vegetable (Organic) Fruit Fruit (Organic) Meat Meat (Organic) Dairy Dairy (Organic) Flowers & Plants Baked Goods Baked Goods (Gluten-Free) Crafts & Arts Other Other categories List all possible products you will be selling at the market*Please write a short description of your products/business to be posted on our website, marketing, and our weekly email distributions:* List all persons who will represent your business at the market ("vendor personnel"):*Business License - required. Provide copy of one of the following as proof you are a business:*Accepted file types: jpg, png, pdf, jpeg, Max. file size: 100 MB.Federal ID number* County Assumed Name* Articles of incorporation/partnership* Selling Licenses Depending on the product(s) you sell, you must attach copy(s) of licenses and certifications required by Operating Guidelines. Check the attached appropriate non-shaded boxes for each product category you sell and provide the date of the last Health Inspection. Which licenses are you uploading?* Organic Certification (If applicable) Sales Tax License (Plants/Artisans only) Nursery Stock or Growers License Food Establishment License Food Warehouse License No Food Establishment License required, as the business qualifies under 2010 Michigan Cottage Food Law. Note: A Health Inspection may be required on all products such as baked goods (Cottage Food exempt), candy, cider, poultry, honey, etc. The Health agencies that govern this market operation are: Washtenaw County Environmental Health: http://www.ewashtenaw.org and Michigan Department of Agriculture: http://www.michigan.gov/mdard Copies of any inspections by these agencies and licenses must be attached with a sample of your label.Organic Certification Drop files here or Select files Accepted file types: jpg, png, pdf, jpeg, Max. file size: 100 MB. Sales Tax License (Plants/Artisans only) Drop files here or Select files Accepted file types: jpg, png, pdf, jpeg, Max. file size: 100 MB. Nursery Stock or Growers License Drop files here or Select files Accepted file types: jpg, png, pdf, jpeg, Max. file size: 100 MB. Food Establishment License Drop files here or Select files Accepted file types: jpg, png, pdf, jpeg, Max. file size: 100 MB. Food Warehouse License Drop files here or Select files Accepted file types: jpg, png, pdf, jpeg, Max. file size: 100 MB. By signing below, I certify that I have read and understand the Operating Guidelines and that all licenses and certification listed above are current and valid. I understand that should I, or any vendor personnel fail to comply with the Operating Guidelines, my participation in the Chelsea Farmers Markets can be terminated. As a vendor wishing to participate in the Chelsea Farmers Markets, I along with vendor personnel agree to save, hold harmless and indemnify the markets and property owners from any and all liability or responsibility pertaining to any damages to person or property on the site assigned to me (us) by the market, when such damages or liability arise out of acts of my own or my vendor personnel.Signature*PhoneThis field is for validation purposes and should be left unchanged.