APPENDIX G

City of Harlingen

VENDOR REGISTRATION FORM

Vendor Name: ___________________________________________________________

Business Location: ________________________________________________________

                    ____________________________________________________________

Contact Phone: __________________________________________________________

Vendor Home Address: ____________________________________________________

                     ____________________________________________________________

Product Vending: _________________________________________________________

Duration of Permit Request (maximum 1 year): _________________________________

FEE: $10.00

_________________________________                ______________________________
VENDOR SIGNATURE                                            DATE

Property Owner/Lessee: ____________________________________________________

Business Name: __________________________________________________________

Business Address: ________________________________________________________

I, the property owner/lessee at the location of the business described above give this vendor permission to use parking and bathrooms provided on my property/business site for the use of said vendor’s customers for the time period specified in the request.

_________________________________                   ______________________________
OWNER/LESSEE SIGNATURE                                  DATE

This permit may be revoked by vendor and/or lessee by providing written notification to city planning staff. Permit remains valid for the period specified above. If no specification is made, the permit will be valid for one year from the date of issuance.

FOR OFFICE USE ONLY:

Registered ____________ Duration _____________ Expires ____________ Parking Check __________

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