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