Application Form

- (go to print option on your PC to print out this one page application form)

Name: ___________________________ Tel: ______________ Email: _______________

Address:________________________________________________________________

Trading Name: (if applicable) ___________________________

Product Description: ______________________________________________________

_______________________________________________________________________

Amount / Continuity: _______________________________________________________

Other outlets Supplied: ____________________________________________________

Space required for Stall – Size and Shape*: ____________________________________

*You must supply your own stall, any covers used must be of high quality material. 

Do you require:         full stall ٱ               or a shared stall ٱ

If shared please give details of who you plan to share with and arrangement plans:

 ____________________________________________________________________________

Do you require a power point?          Yes: ٱ         No: ٱ

 Are you: (Tick Box )          Organic Producer ٱ                                 Licence Number: ____

                                               In Conversion to Organic Producer ٱ  Licence Number: ____

Do you use any specific label or words to describe your produce? _______________
_______________________________________________________________________

Will products that differ from this be clearly identified? ________________________
_______________________________________________________________________

Product and Public Liability Insurance.
This is essential for anyone trading at the market.
Insurance Company: ____________________ Policy Number: _____________________

Are you licenced with the Health Board or other agency?    Yes: ٱ           No: ٱ

Please give any other relevant information that may help with processing your application form. For example Market experience:
________________________________________________________________________
________________________________________________________________________

Have you read the Athy Farmer’s Market terms & conditions &enclosed a signed copy:

Yes: ٱ       No: ٱ

 Signed:__________________________________Date:__________________

Application forms must be returned to Liam Ryan, Moyleabbey Organic Farm, Ballitore, Athy, Co. Kildare.

For more information please contact mobile no. 0872153332