Farmers Market 2024 Sign Up October 13, 2024 12–5 p.m. Name* First Last Email* Phone*Address* Street Address City StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Farmer's Market Sign Up* Price: City of St. Charles - Required InformationPlease fill out the following section that is a legal requirement from the City of St. Charles for Promoters/Business Licenses for our Farmer's Market. Type of Booth* What type of Business?* For-Profit Non-Profit Business Name* Contact Name* Sales Tax ID Product(s) Sold* Vendor Liability Waiver*Academy of the Sacred Heart — Country Fair Farmers MarketMarket Contact Information: Louise Kuhlmann — kuhlmann.louise@gmail.comLiability of WaiverThe Academy of the Sacred Heart does not cover product liability for individual vendors or liability for personal damages caused by your market display. {The below, undersigned vendor} I understand that individual product liability and liability for market display is the vendor’s/my responsibility. I do hereby release the Academy of the Sacred Heart from legal or financial liability due to my products and/or market display (and negligence). Release & Indemnity ClauseI agree to indemnify and hold harmless the Academy of the Sacred Heart, its employees and volunteers from all claims, causes of action, liability, judgments, obligations, or costs of any nature, including but not limited to costs and attorney fees, in connection with any such claims or the like made by or on behalf of any individual and/or entity, including the individual or entity’s spouse, children, heirs, assigns, insurers, guarantors, officers, directors, agents. By checking this box on behalf of myself individually, and on behalf of my business, I acknowledge that I have read and understand the Liability of Waiver and Release & Indemnity Clause and agree to be bound by and comply with the terms.Initial Here* Total $0.00 Payment Method*PayPal CheckoutCredit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Card Number Expiration Date Expiration Date Security Code Security Code Cardholder Name
