Applicant Information

Company:

Full Name:
First Last

Address:
Street Address Apartment/Unit #

City

State

ZIP Code

Home Phone: Email Address:

Fax Number:

Please provide a brief description of what will be sold

Event Information

Choose your Dates Flea Market: May 12th _______ $10 per 8 foot table Spaces needed ______ June 31st _______ $10 per 8 foot table Spaces needed ______ Craft Show August 25th _______ $10 per 8 foot table Spaces needed _______ October 13th _______ $10 per 8 foot table Spaces needed _______ Total amount enclosed ________ Spaces subject to availability; spaces available on a first come, first serve basis Please return this application, with your fee to: 84 Country Store 101 Creamery Road Greentown Pa 18426 Checks payable to 84 Country Store

Email Questions to 84countrystore@gmail.com Attention SHOW

Email Questions to 84countrystore@gmail.com Attention SHOW