Mount Holly Farmers Market Grower/Producer, Value Added Products, or Artisan Vendor Application

Email address *

Farm or Business Name *

Your answer

Name of Owner *

Your answer

Mailing Address *

Your answer

Business Address (if different from mailing address)

Your answer

Primary Telephone Number *

Your answer

Cell Phone Number (if different from primary)

Your answer

Email Address

Your answer

Preferred contact method

Call primary telephone number

Call cell phone number (if applicable)

Text Message

Do you have any of the following? (check all that apply)

Website

Facebook

Etsy

Other

List any of the above that you would like for us to have and help you publicize:

Your answer

Emergency Contact *

Your answer

Emergency Contact Telephone Number *

Your answer

Alternate Vendor Representative

Your answer

Alternate Vendor Representative Telephone Number

Your answer

Partner Producer(s) Information (if applicable)

Your answer

Select the option that applies to your business *

NC Department of Revenue Certificate of Registration # (attach copy later)

NC Agricultural Exemption # (attach copy later)

I attest that I am exempt, as I am only selling products produced on my farm that have not been processed or value added. (NOTE: selecting this option and submitting this form is effectively providing your electronic initials and serves as an attestation of your exempt status)

NC state laws require us to obtain a copy of your Certificate of Registration, if you are required to have one, and maintain this information for a period of no less than two years. State law also dictates that a copy be on display at your booth for inspection. You must be willing to furnish a copy for our records, should your application be approved, and display a copy at your booth. *

I understand and agree.

I do not have one because I am exempt.

I do not have one and am unsure if I need one or not.

You will also be required to maintain and furnish any additional applicable certifications, such as a meat handler's certification, grower's certification, dairy inspections, nursery inspections, health department inspections, sanitation grade, kitchen certification, etc. *

I understand and agree.

I do not have any of the above because they do not apply to my business

I do not have any of the above and am unsure if I need them or not.

Categories of items to be sold at the market (NOTE: Addition of items not listed in the application is not permitted without the approval of the Market Manager) *

Your answer

For planning purposes, ALL VENDORS should let the Market Manager know by 6:00 PM on Friday before the market if you will be absent. Vendors may not sell until the application is completed, approved, and fees are paid. General Release: I hereby release and agree to indemnify and hold harmless the Mount Holly Farmers Market and Manor on Main or affiliated parties (board, officers, agents, employees and volunteers) from claims due to lost or damaged property, personal injury, or death resulting in whole or in part from vendor’s use of or presence at the subject premises. I am responsible for property in my possession. I am responsible for obtaining and displaying the appropriate required NC Sales and Use Tax ID within my booth. *

I agree and recognize that by selecting this option and submitting this electronic application I am effectively providing my electronic initials and acknowledge that I have entered into an agreement with the Mount Holly Farmers Market, Inc. and all affiliated and interested parties.

By typing your name here you are effectively providing your electronic signature and acknowledging that you are entering into an agreement with the Mount Holly Farmers Market, Inc. and all affiliated and interested parties. You are also attesting that all the information you provided is true and accurate to the best of your knowledge.

Your answer

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