Pioneer Day Committee of Lafayette County Florida       116 SW Monroe Ave. Mayo, FL 32066 *(386) 294-2705* www.lafayettecountychamber.com

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PRIMARY CONTACT NAME: __________________________________________________________________

BUSINESS NAME: ____________________________________________________________________________

ADDRESS:___________________________________________________________________________________

CITY: ___________________________________________________ STATE:  _____________ ZIP: ___________

COMPANY: __________________________________________________________________________________

HOME PHONE:_________________________  BUSINESS PHONE: ____________________________________

TAX NUMBER: _______________________________________________________________________________

EMAIL ADDRESS: _______________________________SPACE# (S) PREVIOUS YEAR____________________

Please Note:

Ø      To receive a space a current copy of your tax number must be included. If we do not receive a tax number we will be unable to assign a space.

Ø      Spaces are given on a first come first serve basis

Ø      Vendors purchasing a space for both Friday and Saturday will receive a discount, shown below.

Ø      Applications not POSTMARKED by August 31^st, 2010 will be subject to a 10% late fee, due before both space is assigned, be sure to have correct contact numbers above.

Ø      No vendor will be allowed to break down until closing for that day.  Any vendor found breaking down before closing for that day will not be invited to participate next year.

Ø      Craft spaces are 12 by 12 feet, food spaces are 12 by 24 feet (ENLARGED SPACES!!).

Ø Generators will be allowed within the park that create no more noise than an idling vehicle.

~PLEASE CHECK THE APPROPRIATE BOXES~

SPACE TYPE		SAT ONLY By 8/31/10	SAT ONLY After 8/31/10	Regular Weekend Price (for information only)	FRI & SAT 8/31/10	FRI & SAT After 8/31/10
	SINGLE SPACE	$50.00	$55.00	$100.00	$72.00	$88.00
	DOUBLE SPACE	$75.00	$82.50	$150.00	$117.00	$128.70
	TRIPLE SPACE	$100.00	$110.00	$200.00	$162.00	$198.00
	FOOD SPACE 1-3 ITEMS	$95.00	$120.00	$190.00	$171.00	$188.00
	FOOD SPACE 4+ ITEMS	$190.00	$209.00	$380.00	$342.00	$376.00
	WATER	Please note that we do not charge extra for water or electricity access as we cannot guarantee the level of service or availability.
	ELECTRICITY

AMOUNT ENCLOSED: _______________________________ (No spaces will be assigned until paid in full)

 GENERAL DESCRIPTION OF ITEMS:________________________________________________________

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I hereby acknowledge and agree to the above information and conditions.

 ____________________________________________________                _______________      Signature                                                                                                                                                 Date

OFFICE USE ONLY     CHECK#/CASH/MO_________________            SPACE ASSIGNED: ____________________

CONFIRMATION SENT: __________      COMMENTS: _____________________________________________________________