Food Vendor Application Business Name (Legal)(Required) Business Name (To Be Advertised)(Required) Contact Name (who should we mail parking pass & tickets to)(Required) First Last Billing Name(Required) First Last FaceBook Page Twitter ID Website Address Mailing Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican 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 Email(Required) Phone(Required)Please review the following checklist:Does the Gloucester County Wine Festival have your permission to list your company’s name in printed media and on GloucesterVaWineFestival.com?(Required) Yes No Were you a vendor last year?(Required) Yes No Is electricity needed (we will notify you if we can accomodate)(Required) Yes No Please upload your of liability insuranceMax. file size: 256 MB.Please upload your menuMax. file size: 256 MB.Please upload a picture of your booth as it will appear at the FestivalMax. file size: 256 MB.Health permit(Required) I already have a Health Permit I will apply for a Temporary Health Permit I do not require a Health permit for my business Signature(Required) Reset signature Signature locked. Reset to sign again Booth Space (Booth 1)(Required) Before 8/15 After 8/15 If a second booth is needed, please select second booth below. Booth Space (Booth 2) Before 8/15 After 8/15 No additional booth Are you a Gloucester of Chamber of Commerce Member?(Required) YES NO Total fee charged Payment MethodCredit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Security Code Cardholder Name