Vendor Signup Form

Vendor Signup Form

This form is utilized to sign up as a vendor for any of our upcoming events.
Enter Your Information

Full name, contact, and details about your company
Full Name*

First NameLast Name
Company Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email Address*
example@example.com
Phone Number*
(000)000-0000
Company Name*
Example: Imani Behavioral Health
Event*
Tell us about yourself, your company, and desserts/products you plan on bringing.*
Facebook
Example: facebook.com/imanibehavioralhealthservices
X (formally known as Twitter)
Example: @imani_bh
Instagram
Example: @imanibehavioralhealth
TikTok
Example: @imanibehavioralhealth
Please upload your company logo. If you do not have a logo, please provide a headshot.*

Requirements: Hi-res logo/photo in .png, .ai, or .jpg file formats.
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Disclaimer

By signing up for this event and once all information and fees due pertaining to the event have been accepted, you are granting us permission to use your likeness, your company's public contact and social media information, and logo in any promotions and marketing material pertaining to the event prior to the event and after the event. Due to limited slot availability, no refunds will be given in the event one's submission and payment is accepted but the individual/company decides not to participate as a vendor.
Please verify that you are human.*
Though we are accepting vendor submissions now, vendor fees can be made at a later time, if necessary. However, due to limited available slots, they will be filled on a first come, first serve basis.
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Vendor Fee
Your vendor fee covers your parking and vendor space. Vendors must bring their own table and equipment. Vendors keep 100% of their proceeds unless vendors explicitly express a desire to donate a percentage. Donations are appreciated but not expected.

$25.00

Subtotal

$0.00

Tax

$0.00

Total

$0.00

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

Vendor Signup Form

Enter Your Information

Disclaimer