PUEBLO OF TESUQUE FLEA MARKET 2016 Application For

PUEBLO OF TESUQUE
FLEA MARKET
2016 Application For Vending & Vendors Permit
Aplicacion para licencia de permiso
NAME:
Nambre: ______________________________________________________________________________________________
FIRST NAME:
LAST NAME:
MIDDLE INITIAL:
(Primer Nombre)
(Apeido)
(Letra inicial del
Nombre del medio
EMAIL ADDRESS (PLEASE PRINT) : ____________________________________________________________
BUSINESS NAME (IF APPLICABLE):
Nombre del Negocio (Si es aplicable):_________________________________________________________________________
ADDRESS:
Direccion:______________________________________________________________________________________________
CITY:
STATE:
ZIP:
Ciudad:__________________________________ Estado:________________________________ Codigo Postal:____________
FED TAXPAYER I.D. # OR SOC.SEC. #:
El número del identification federal : ______________________
STATE TAXPAYER I.D.:
El número de identificacion del estado:_________________
PHONE #:
CELL PHONE #:
Telefono: _________________________ Celular: ______________________
OTHER:
Otro: _____________________________
DRIVER LICENSE NUMBER:
STATE:
El número de licencia de conducir:_____________________________ Estado:______________________________________
LIST ALL ASSOCIATES EMPLOYED BY YOU:
Lista de los empleados asociadas al negocio: __________________________________________________________________
_______________________________________________________________________________________________________
VEHICLES: List all vehicles owned or operated by you and associates. Copies of Driver’s license and vehicle insurance are
required on all vehicles Vehiculos: Listas de todos los dueños. Copias de licencias de conducir aceguransas de los vehiculos requeridos
YEAR:
MAKE & MODEL:
COLOR:
Año ___________ Marca y modelo: ______________________________________________ Color: ________________
LICENSE PLATE #:
STATE REGISTRATION:
OWNER:
Número de licencia de la placa:_________________________ Registracion del estado: _________________ El dueño: ______________________________
------------------------------------------------------------------------------------------------------------------------------------------------------------------------YEAR:
MAKE & MODEL:
COLOR:
Año ___________ Marca y modelo: ______________________________________________ Color: ________________
LICENSE PLATE #:
STATE REGISTRATION:
OWNER:
Número de licencia de la placa:_________________________ Registracion del estado: _________________ El dueño: ______________________________
------------------------------------------------------------------------------------------------------------------------------------------------------------------------YEAR:
MAKE & MODEL:
COLOR:
Año ___________ Marca y modelo: ______________________________________________ Color: ________________
LICENSE PLATE #:
STATE REGISTRATION:
OWNER:
Número de licencia de la placa:_________________________ Registracion del estado: _________________ El dueño: ______________________________
EMERGENCY CONTACT:
Contacto de Emergencia: ____________________________________
PHONE #:
Telefono: ____________________________________________
LIST ALL MERCHANDISE TO BE SOLD BY YOU THE APPLICANT AND YOUR ASSOCIATE(S) MUST BE LISTED IN DETAIL. IF YOU
WOULD LIKE TO MAKE ANY CHANGES DURING THE SEASON PLEASE DO SO IN WRITING, subject to approval by the General
Manager.
Lista de toda la mercancia que sevenderan con los aplicados asociados con una lista de de talles. Y si quiere acer unos cambios
durante la temporada enscribir los subjetados y aprovados por el jefe general
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
I HEREBY AUTHORIZED THE INVESTIGATION OF ALL STATEMENTS CONTAINED IN THIS APPLICATION, I UNDERSTAND THAT
ANY MISREPRESENTATION OR OMISSION OF FACT REQUESTED IS CAUSE FOR DENIAL OF THIS APPLICATION AND DENIAL OR
REVOCATION OF THE VENDORS PERMIT (PER TAX ADMINISTATOR) AND EVICTION FROM THE TESUQUE PUEBLO FLEA MAREKT
PROPERTY. THE PERMIT ISSUED TO VENDORS AT THE FLEA MARKET MAY ONLY SELL WITHIN THE FLEA MARKET PROPERTY
Yo intiendo y autoriso de investigar el estado que contiene esta aplicacion sobre la identidad de mi persona o algun problema
pueden revocar el permiso de venta (per tax administacion) revisada por el Pueblo de Tesuque Flea Market.
PRINT NAME:
Escriva su nombre: ________________________________________________
APPLICANT SIGNATURE:
Firma del aplicante: ________________________________________________
DATE:
Fecha: ___________________________
THIS SECTION TO BE FILLED OUT BY THE PUEBLO OF TESUQUE FLEA MARKET MANANGEMENT ONLY!
!COMPLETA PARA ADMINISTRACIÓN SOLAMENTE!
IS THIS APPLICATION FOR: NEW PERMIT: ________ RENEWAL ___________
APPLICATION IN GOOD STANDING? YES OR NO? IF NO LIST ANY VIOLATIONS
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
PROOF OF INSURANCE PROVIDED YES OR NO (A COPY MUST BE IN OUR FILE BEFORE YOU OPEN)
DATE APPLICATION FILED: __________________
DATE VENDOR PERMIT/LICENSE EXPIRES: _________________________
APPROVAL: _____________________________________
DENIAL: _____________________________________________
CHECK LIST FOR FILE (ONLY FOR PERMANENT):
APPLICATION WITH SIGNATURE _____
RELEASE AND INDENIFICATIONS AGREEMENT _________
LIABILITY INSURANCE OF 1 MILLION ________
COPY OF DRIVER’S LICENSE __________
LIST OF ALL ASSOCIATES, INCLUDING COPIES OF DRIVER LICENSE & VEHICLE INSURANCE ____
1. NEW VENDOR THE UNDERSIGNED AGREES TO BE PRESENT FROM ________ TO _________ OF THE CURRENT YEAR
Nuevos vendedores emos firmados y entendido desde el presente des de _______ para ______ el año cuerente
2. PAYMENT THE UNDERSIGNED AGREES TO PAY FIRST AND LAST MONTH RENTAL FEES FOR:
Pagos firmados y entendidos, pagar el primer mes yel utimo cargos requeridos:
3. DEFAULT: THE UNDERSIGNED ACKNOWLEDGES AND AGREES THAT IF HE/SHE DEFAULTS THIS BY LEAVING BEFORE THE
MONTH OF DECEMBER HE/SHE WILL FORFEIT THE LAST MONTH’S RENT AND SPACE(S) ASSIGNED
Retirarce: firmo y entiendo si el o ella seretiran y se van antas del mes de dicenbre ella/el se olvidan de el ultimo mes rentado y el espacio(s)
asignado
4. THE TESUQUE PUEBLO FLEA MARKET AND THE PUEBLO OF TESUQUE TRIBAL COUNCIL RESERVES THE RIGHT TO CHANGE,
AMEND , DELETE ANY OR ALL ITEMS AT ANY TIME WITH OR WITHOUT PERMISSION
El Tesuque Pueblo Flea Market y el Pueblo de Tesuque tribu consulas tiene la orden y el derecho de acer cambios y borrar cosas, todo el tiempo
con o sin permiso
5. THE TESUQUE PUEBLO FLEA MARKET RESERVES THE RIGHT TO REFUSE SERVICE TO ANYONE
El Tesuque Pueblo Flea Market tiene la order y el derecho, de retractarse a cualquiera
_______________________________________
VENDOR’S NAME
Nombre de Vendedor
_______________________________________
VENDOR’S SIGNATURE
Firma del vendedor
_______________________________________
DATE
Dia
_______________________________________
PERMIT NUMBER
Numero de permiso