Casual Stallholder Application

Personal Information

Stall Holder's Name

Registered Business Name (if applicable)

ABN (if applicable)

Market Stall Name

Website

Email Address

Phone Number (bh)

(ah)

Mobile

Postal Address

Residential Address while in Broome

Anticipated Commencement Date at Market

Broome Residents

Courthouse (Saturday)Courthouse (Sunday)Staircase MarketThursday Night

Attach a copy of your driving license and advise your trading preferences

Please list your town and state of residence:

How long you intend to trade in Broome:

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Licenses and Permits

Relevant Legistative Licenses/Permits

Certificate of Registration as Food Business (Shire of Broome)

AttachedTo be obtained upon application approval

Public Liability

AttachedTo be obtained upon application approval

Do you Sell Products from a Retail Outlet?

NoYes
If Yes, please specity

Attachments

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Contact Information

Please tick the relevant box/es: I give permission for Broome markets to give out the following

MobileBus. PhoneHm. PhoneEmailPostal AddressFor Enquiries

Consent

I declare that, I have read the Broome Community Stallholder Association (BCSA) Rules and Regulations and to the best of my knowledge, all the information supplied by me is correct

Casual Stallholder Application

Casual Stallholder Application

Personal Information

Stall Holder's Name

Registered Business Name (if applicable)

ABN (if applicable)

Market Stall Name

Website

Email Address

Phone Number (bh)

(ah)

Mobile

Postal Address

Residential Address while in Broome

Anticipated Commencement Date at Market

Broome Residents

Attach a copy of your driving license and advise your trading preferences

Please list your town and state of residence:

How long you intend to trade in Broome:

Stalls Informations

Category of Stalls

Information Stalls

Stall Size

Please stipulate the exact dimensions

Do you use gazebo/tent?

Do you use a van?

Do you use Electrical Items?

Do you use a van?

List Your Cooking Methods at the Market

(eg. flames grill, hot plate, deep fryer, etc)

List Your Cooking Methods at the Market

(N/A service and information stalls unless you wish to sell supporting products)

Product Concept/Design

Product Production

Note: Preference is given to self-made, local made craft and services, Commercial imported products and franchise based products are subject to approval.

How will your Stall and Product be Displayed

Attach photos if available

Number of People to Run the Stall

(Note the stallholder listed on this form is required to be the principle person to operate the stall)

List All Car Registration Numbers for you and Ancillary Staff

Licenses and Permits

Relevant Legistative Licenses/Permits

Certificate of Registration as Food Business (Shire of Broome)

Public Liability

Do you Sell Products from a Retail Outlet?

Attachments

Contact Information

Please tick the relevant box/es: I give permission for Broome markets to give out the following

Consent

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