Sip & Shop Vendor Registration

Name(Required)

First Last

Business Name(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code

Phone(Required)

Email(Required)

Brief Description of Merchandise(Required)

Your item for the vendor raffle

(minimum of $50 in value)

Is an electrical outlet require?(Required)

Yes

If an electrical outlet is required please explain why

Space fee (includes an 8ft table with a linen)(Required)

Cost is $200

Space fee for 1 additional table (includes an 6ft table with a linen)(Required)

None

Cost is $50

Payment Method

Credit Card

Subtotal

$0.00

If you would like to pay for the 3.5% processing fee please click YES below

YES

Subtotal

$0.00

CC Processing Fees

Price: $0.00

Total

Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

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