Farm or Business Name *

Name of Owner *

Mailing Address *

Business Address (if different from mailing address)

Primary Telephone Number *

Cell Phone Number (if different from primary)

Email Address

Preferred contact method

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

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

Emergency Contact *

Emergency Contact Telephone Number *

Alternate Vendor Representative

Alternate Vendor Representative Telephone Number

Partner Producer(s) Information (if applicable)

Select the option that applies to your business *

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. *

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. *

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) *

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. *

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.