Vendor Application

*Vendor Name: _______________________________________________________________
*Street Address: _______________________________________________________________

*City: ____________________________________*State: _________*Zip Code: __________

*Phone Number: _____________________________ Fax: _____________________________

Email Address: ________________________________________________________________

Items to be sold: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

If not retail, purpose of booth: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

________ 10 X 10 space ($50.00)
________ Larger space requested ($100.00).
                  Please indicate requested space size _________________
________ Require access to electricity (extra fee $10.00)

________ Total Vendor Fee

Circle One
-Check Enclosed   Payable to Big Bend Bike Rally        Check #_____________

-Pay with Visa/ -Pay with MasterCard #_________________________________
Name on Card ___________________________ Billing Address ______________________
City _____________________________ State _________ Zip Code ____________
Card Exp. (00/0000) _________________ Security Code (3-4 digit number on back of card) ______

You must furnish all your own display equipment, weather protection, unloading equipment, and tent weights or supports.

Please return this form with your entry fee to:

Big Bend Bike Rally
P.O. Box 401
Great Bend, KS 67530