Vendor Application - Weekend of Fear

Vendor Application

* indicated required field

Company Name: *
Contact Name: *
Phone Number: *
Email Address:
Web Site:
Mailing Address:
State:  Zip:  

PA Sales Tax License Number: *

Number of Tables Requested: *
If more than 4 tables will be needed please contact
If power is required, please check here  

Description of Company and Merchandise:

Booth Type:

Description (if other):

I have read and agree to the Vendor Information: *   I AGREE

Mail this form along with your check or money order (US dollars only)
$200 per table to:

Mr Hush LLC
693 Route 739, Suite 2, PMB 144
Lords Valley, PA 18428