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2015 AMERICAN PIE – 4TH OF JULY
NON-FOOD VENDOR REGISTRATION FORM
Name of Organization/Company: _____________________________________________________________
Contact Person: _______________________________ Phone ________________ FAX _______________
Mailing Address: __________________________________________________________________________
Street Address/P. O. Box #
_______________________ ____________
____________
___________________________
City
Zip Code
Email address
State
NON FOOD Vendor (arts and crafts, not for profits, no “store”) $40.00 ____
Retail/Service Business, Political Candidates $150.00 ____
Electricity $20.00 additional per outlet (15 amp max) # of outlets _____ Total electrical fee _____
Indicate any special needs. You must provide your own extension cords.
# Of spaces needed _______ (maximum size of space is 10’ X 10’)

Describe type of unit, size or set up (ex. Tent, RV, trailer, etc.) and maximum exterior
dimensions
____________________________________________________________________________
Note: If your total set up does not fit into a 10 X 10 ft. space, additional spaces will need to be purchased.
Describe ALL items for sale, services provided or items to be given away free. Please note that you may be
restricted from giving away certain items if they conflict with the exact items being sold (Please be specific).
You ARE NOT permitted to sell or give away any food or drink products.
NO SALE OR DISTRIBUTION OF ANY FOOD OR DRINK PRODUCTS WILL BE PERMITTED
ELECTRICITY WILL NOT BE AVAILABLE TO YOU UNLESS REQUESTED ON THIS FORM
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By submitting an application, I agree to abide by the rules set forth by the American Pie – 4 of July committee,
and I understand that the Rotary Club of Orange Park, Rotary Club of Green Cove Springs, the City of Green
Cove Springs, including its council and/or staff, Reynolds Park, or any event sponsor are not responsible for the
loss or damage of work, and/or any claims, injuries, costs, damages or any other liabilities which may result. I
further agree to hold harmless all entities associated with this function. I am further responsible for
communicating all such rules and provisions to any other individuals associated with my activities.
We will make every effort to avoid duplication of products and services or for similar vendors to be in close
proximately to each other. There will be, however, no guarantee or exclusivity for products, services or location.
On the day of the event once assigned a location, there will be no moves unless the area is deemed unsuitable
by the event coordinator.
Payment type: Check number ________ enclosed $ _________*Sales Tax #_______________________
*If you need a Sales tax # for the event contact Dept of Revenue at 386-758-0420
Signature ______________________________________
(ALL MUST SIGN)
IMPORTANT: Vehicles WILL NOT be allowed in the vendor area from 9:30 AM until after the
fireworks are completed and ALL PEDESTRIANS HAVE EXITED THE RIVER ROAD/VENDOR
AREA.
Please make checks payable to RCOP (Rotary Club of Orange Park)
CHARITABLE FOUNDATION. Mail registration form and checks to:
American Pie – 4th of July
Attn: General Vendor
P. O. Box 445
Orange Park, FL 32067-0445
NO RAIN DATES – NO REFUNDS
General vendors can contact Carla Adcock at (904) 264-0520