Fridays from 5pm - 9pm, June 1 - October 26, 2018
Located at 5th Ave and 12th St. Moline, IL 61265

APPLICANT INFORMATION


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Accepted as Payment: (check all that apply) Debit Credit EBT WIC#

*All applicants must submit a completed application, proof of insurance, and any other required documentation per state and federal law to be considered for space assignments.


Receipt of this application is not confirmation of an assigned space.


Describe featured product(s):

Select equipment you will be using in your vendor space:
Generator Canopy Car/truck Trailer

Other
**outdoor spaces are 10 feet wide.

By checking this box, I give permission for the Mercado on Fifth to post pictures of me and/or my products(s), as well as consent for my contact information to be given to returning and potential customers.