Christmas in the Village of Powhatan

P.O. BOX 156

POWHATAN POINT, OHIO 43942

EVENT: 15th ANNUAL CHRISTMAS IN THE VILLAGE OF POWHATAN

DATE: NOVEMBER 13th, 2021 (SECOND SATURDAY IN NOVEMBER)

APPLICATION FOR: Food Vendor

PLEASE RETURN THE BOTTOM PORTION ALONG WITH $75.00 FEE PER LOCATION ASAP. MAKE CHECKS PAYABLE TO CITV AND MAIL TO THE ABOVE ADRESS. PLEASE INCLUDE A COPY OF YOUR VENDOR’S LICENSE AND PROOF OF INSURANCE. YOU CAN NOT SET UP IF WE DO NOT HAVE THESE ON FILE AS PER THE BELMONT COUNTY HEALTH DEPARTMENT.

CITV CONTACT: JEREMY SIMS 404-993-5079

1. BUSINESS NAME _____________________________

2. OWNER _____________________________________

3. ADDRESS _____________________________________

4. PHONE# ______________________________________

5. DO YOU NEED ELECTRICTY FOR THE DAY AND WHAT TYPE OF HOOK UP DO YOU NEED? _________________________________________

6. MENU FOR THE DAY _____________________________________

(REVERSE SIDE IF NEEDED)

PLEASE BE SET UP AND READY TO GO BY 9:00 AM ON SATURDAY NOVEMER, 13TH.

I AGREE TO HOLD CHRISTMAS IN THE VILLAGE OF POWHATAN, INC., ITS’ OFFICERS AND ASSOCIATES HARMLESS FROM ANY AND ALL LIABILITIES.

SIGNATURE ______________________________________

PRINT __________________________________________

DATE ___________________________________________