Metro Health Farm Market Application

Metro Health University of Michigan Health Farm Market at Metro Health Village

I want to be considered for a seasonal vendor spot (at the market every Thursday for the entire or majority of the season)
I want to be considered for a daily vendor spot (at the market when daily spot is available or for a portion of the season)

Product Category (Check all that apply)

Other - Please Specify

Vendor Category (Check all that apply)

Farmer (100% grower)
Farmer with locally purchased supplement (grows minimum of 51% of own products)
Artisan
Other

Other Vendor - Please Specify

Type of Business

Total years of operation

Type of Business Other

Name of Farm/Business

Primary Contact Name

Alternate Contact Name

Emergency Contact Name & Number

Address

Street Address Address Line 2 City State ZIP Code

Phone

Fax

Cell

Email

Website

Insurance Agent (General Liability) Name:

First Last

Phone

Type of Insurance

Please list ALL individuals who will be your onsite manager (include yourself) and provide phone numbers for each:

Name

First Last

Phone

Name

First Last

Phone

Name

First Last

Phone

Products to be sold

Please list all products sold and their sources (own farm, purchased from local farm) Attach additional sheet if necessary.

Product

Source

Product

Source

Product

Source

Product

Source

Product

Source

List below the license and inspection numbers required for the operation of your business and/or sale of your products, and any other license, registration, certification, or permit required by local, state, or federal law. Provide copies of all current and valid licenses, registrations, certifications, or permits with your registration.

Michigan sales tax license number

Nursery dealer license number

Plant dealer license number

Plant or nursery inspection number

Organic certification license number

Other relevant license number

Other relevant inspection numbers

Provide copies of all current and valid licenses, registrations, certifications, or permits with your registration.

Metro Health University of Michigan Health Village Stall Assignments

Metro Health University of Michigan Health Village provides an excellent location to host the farm market. There is plenty of community attendance and employees from the hospital and surrounding businesses that visit each week.

As a hospital, our first priority is the care of our patients and their families. We ask that you acknowledge the steady patient and urgent traffic flow throughout the village. At no time should patient traffic be interrupted. The market manager or hospital security may request that you move your stall or vehicle at any time during the market.

The Metro Health University of Michigan Health Farm Market will take place in Metro Health Village at 5900 Byron Center Ave SW, Wyoming, Michigan. The 2017 stall fee will be $100 per 10’x10’ space for the season or $20 per day per 10’ x 10’ space. This should provide adequate room for parking of one vehicle and display space.

The 2017 season is considered to be Thursdays, May 11, 2017 – October 12, 2017, 9 a.m. – 2 p.m. Seasonal vendors will be provided the same space at each weekly market; daily vendors will be assigned spaces as available. Space location will be based upon seniority and all assignments will be at the discretion of the market manager.

Notice for All Farm Market Vendors

You must notify the market manager one week in advance if you will not be attending the market. This courtesy allows your stall to be used by a vendor on the waiting list to maintain market “fullness” and appeal.

Please Note: While participating in the Metro Health University of Michigan Health Farm Market, you may be photographed or videotaped for educational, public relations and promotional purposes.

Signature

Vendor’s signature verifies that the above information is complete and correct. The vendor has read, understands and agrees to all provisions in the market rules of operation including all Michigan Food & Safety guidelines & laws. The market rules can be accessed in the market office or online. Inspection of Vendor’s farm/place of business by market management may occur as a condition of selling at the market.

Signature

Date

Print Name

First Last

Date

Approximate Date I can start

Approximate Date I can end

Stall Name

Please make check payable to: Metro Health University of Michigan Health Hospital

Seasonal Fee due no later than May 1, 2017

Please contact Farm Market Manager Emil Hannesson at (616) 252-6097 or Emil.Hannesson@metrogr.org with any questions.

2017 Metro Health Farm Market Vendor Application

Please list ALL individuals who will be your onsite manager (include yourself) and provide phone numbers for each:

Products to be sold

Metro Health University of Michigan Health Village Stall Assignments

Notice for All Farm Market Vendors

Signature