1. VENDOR APPLICATION
Name: _______________________________________________________________
Address: ____________________________________________________________ ( P.O. Box #)_____________________
City: ________________________________State_______________________________________Zip__________________
Home Telephone: ______________________Cell_______________________________Work________________________
Business Name: ______________________________________ E-mail:____________________________________
Business Address:______________________________________________________
City: ________________________________State________________________________________Zip_________________
NJ. Vendor’s License Number: _____________________________________________Expiration Date:_________________
Vending Purpose: (Check One): Food:__________$300.00 Merchandise:_________$150.00
Please describe food or items to be sold as well as equipment (if any) to be used on day of event:
____________________________________________________________________________________________________
____________________________________________________________________________________________________
Please Note Carefully!
A current copy of a State or Municipal Vendor’s License must be submitted with application
It is the Vendor’s responsibility to meet all State & Municipal fire/health code regulations
Make all checks or money orders payable to “Coalition Of House Music Entertainment LLC”, P.O. Box 6215,
Newark, New Jersey 07106 by JUNE 12, 2012.
(credit cards will not be accepted
Vendor’s Signature: _____________________________________________ Date: _________________________
Internal Use Only
Location of Vendor: ___________________________
Payment of vendor: Check: Cash________
Does the vendor maintain liability insurance: Yes: No:__________