Wine Festival Vendor Application Printable Vendor ApplicationVineyard/Winery Name* Vineyard/Winery Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraรงaoCyprusCzech RepublicCรดte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRรฉunionSaint BarthรฉlemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweร land Islands Country Phone*Website Email* Owners* Wine Makers* Winery/Vineyard Info/DescriptionWhere is your wine currently available?*Where do you currently advertise?* VENDOR ASSUMES ALL RISK OF AND AGREES THAT THE CITY OF ELIZABETHTOWN SHALL NOT BE LIABLE FOR ANY DAMAGE TO PROPERTY OR INJURY TO OR DEATH OF ANY PERSONS INCLUDING WITHOUT LIMITATION, VENDOR, EMPLOYEES, INVITEES, PATRONS OR AGENTS IN, ON OR ABOUT THE PREMISES. FURTHER, VENDOR AGREES TO INDEMNIFY AND HOLD HARMLESS THE CITY OF ELIZABETHTOWN, ITS EMPLOYEES, SPONSORS, AGENTS & DIRECTORS AND OFFICERS FROM ANY AND ALL CLAIMS, DAMAGES, LOSSES AND EXPENSES WHICH MAY ARISE IN THE USE OF SAID PREMISES. Rules & RegulationsSignatureI would like field passes for employees working within my booth.* Yes No These passes are for workers only and may not be used for guests to gain complimentary event admission.Number of field passes needed:*Please enter a number from 0 to 20.Description of Offerings Each vineyard may choose and serve up to 10 different wine selections, minimum of four selections. Please use the fields below to describe your selections. How many wines will you be serving? (minimum of 4)*45678910 WINE 1Wine Name - 1* Wine Year - 1*Wine Description - 1*Price Per Bottle - 1* WINE 2Wine Name - 2* Wine Year - 2*Wine Description - 2*Price Per Bottle - 2* WINE 3Wine Name - 3* Wine Year - 3*Wine Description - 3*Price Per Bottle - 3* WINE 4Wine Name - 4* Wine Year - 4*Wine Description - 4*Price Per Bottle - 4* WINE 5Wine Name - 5* Wine Year - 5*Wine Description - 5*Price Per Bottle - 5* WINE 6Wine Name - 6* Wine Year - 6*Wine Description - 6*Price Per Bottle - 6* WINE 7Wine Name - 7* Wine Year - 7*Wine Description - 7*Price Per Bottle - 7* WINE 8Wine Name - 8* Wine Year - 8*Wine Description - 8*Price Per Bottle - 8* WINE 9Wine Name - 9* Wine Year - 9*Wine Description - 9*Price Per Bottle - 9* WINE 10Wine Name - 10* Wine Year - 10*Wine Description - 10*Price Per Bottle - 10*Booth Fee* Price: Online Processing Fee* Price: $0.00 Total $0.00 Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20222023202420252026202720282029203020312032203320342035203620372038203920402041 Expiration Date Security Code Cardholder Name