Vendor Application

Boaters Exchange - 2020 Vendor Application

Name (as shown on your income tax return)

Business Name (if different from above )

Billing Address

Address Line 1

Address Line 2

City

State

ZIP Code

Contact Name

Phone

Fax

Product to Be Displayed

Vendor Application $50 Paid By

Check CC

Liability Insurance Certificate Provided

Yes No

Hold Harmless Agreement Provided (Below)

Yes No

ALL VENDORS MUST PARK ACROSS THE STREET. NO EXCEPTIONS.

I have read, understand and agree to the terms and conditions outlined in the attached cover letter and this form. I certify that my insurance, where applicable, is current and will remain current throughout my service as a vendor of Boaters Exchange.

Signature

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Date

Hold Harmless Agreement

The vendor shall hold harmless and indemnify Boaters Exchange, Coastal Angler Magazine, Rockledge Gardens and Southern Pine Lumber, against all claims, suits, actions, costs, counsel fees, expenses, damages, judgments or decrees, by reason of any person or persons or property being damaged or injured by the vendor or any of his employees, or in any capacity during the progress of the work, whether by negligence or otherwise.

The vendor shall further save and hold harmless Boaters Exchange and Coastal Angler Magazine for any injury sustained by said vendor or any person or persons acting under direction of vendor.

This contract shall apply to all jobs contracted to me by Boaters Exchange and Coastal Angler Magazine from this date until cancelled.

Date

Signature

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Printed Name