The Hub Markets Application Form

The Hub Markets
Stallholder Application Form
Name*
Trading Name
Goods/Services*
Site Size*
Undercover:Electricity:
Address

Street Address

CityState / Province

Postal / Zip Code
Contact Phone No*
Format: (000) 000-0000.
Other Contact No
Email Address
example@example.com
www.facebook.com - Your business Facebook address
I/We wish to apply to use the policy maintained by the Lions Club of Manning River IncI/We hold a Current Public Liability Policy
Stallholders must provide a copy of current Public Liability Insurance or agree to accept the General Liability Insurance maintained by the Lions Club of Manning River Inc
Insurer's Name:
Policy Number:
Policy Expiry Date:
Please upload a copy of your Public Liability Insurance Document:

Cancelof
Note's or Comment's
I/We confirm that the above details are correct.

I/We agree to comply with the Terms & Conditions for Stallholders.
Signature

Clear
Date

MonthDayYear
Date
Please verify that you are human*
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The Hub Markets