VENDOR FORM

Please specify in which capacity you are interested and return this form to:
Concerned  Black Citizens of Beloit (CBCB) 1905 Mound Ave, Beloit, WI. 53511.

If you would like to be a vendor on the lawn at New Zion, you will be responsible for providing your own product, table, chairs, brochures, business cards, and display.

There will be a required $45 booth fee for profitable vendors (food, clothing, service products, etc). All non-profit vendors (informational only) may participate free of charge and also must provide your own materials, table, chair, and display.

Vendor Fee: $45 w/out generator or $60 w/generator provided by CBCB, Inc.

To mail the form in, Download and Print the Vendor Form PDF here, or Register online below.

Name *

First

Last

Phone

Email *

Address

Address Line 1

Address Line 2

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Business Name *

Business Phone

Business Address

Address Line 1

Address Line 2

City

--- Select state ---AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingState

Zip Code

Special Requests

Generator, electrical, access to water/restrooms. Please indicate any of your space requirements here:

License Plate Number of Vehicle or Vendor Truck

Brief description of product/service to vend

Social media platforms (IG, website, FB) where you can be found

Make Payment

Below you can make your online payment or you can download our vendor form and bring or mail in.

Payment Options *

• no generator - $45.00
• with generator - $60.00
• I am Non for Profit - no generator - $0.01
• I am Non for Profit - with generator - $0.01

If you are NOT a non for profit us the first two options. Non-Profit organizations use the last two.

PayPal Checkout *

PayPal CheckoutCredit Card

Card Number

Expiration Date

Security Code

Card Holder Name

Vendor Fee: $45 w/out generator or $60 w/generator provided by CBCB, Inc.

Submit