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Name *

First

Last

Address *

City, State & Zip Code *

Phone *

Email *

Neighborhood / Farm *

Product Information *

Type of Product(s) *

Agriculture (i.e. fruits, vegetables, meats, honey, plant starts, etc.),
Prepared Food (i.e. baked goods, dips/spreads, pickled items, spices, etc.)
Home or Skin Care (i.e. soap, cleaning products, lotions, incense, etc.)
Artisan (i.e. jewelry, wood work, planters, t-shirts, knit/crochet, prints, etc.)
Other

Brief Product(s) Description *

Percent (%) Product(s) grown/produced in Kentucky? *

Will you be using your own credit card terminal? *

Are you a Food Truck? *

Describe any special requirements for your business related to the following utilities: *

Please share any other ideas or suggestions that should be considered in operating the Broadway Pop-Up Market: *

Phone