VENDOR APPLICATION

Application and payment due by May 30,2008

Make check or money order payable to:

Mother Road Rally Inc.

Mail completed application and payment to the following:

Mother Road Rally, Inc.

P.O. Box 572 Tucumcari NM 88401

Applications will not be accepted without deposit and proof of insurance.

If there is a problem please contact us as soon as possible.

VENDOR INFORMATION:

Company name: ___________________________________________________

Contact name: ______________________________ Title: ___________________

Street: ____________________________________________________________

City: _________________________________ State: ___________ Zip: __________

Phone: ______________________ E-mail: __________________________________

Describe products or services to be offered: Food ( ) Non-food ( )

Your dimensions Width ______________ Depth __________________ Height ____________

(Include hitches, awnings, accessories, etc.)

FEES:  $100.00 PER SPACE RESERVED

NUMBER OF SPACES NEEDED:   (                      )

Indoor and Outdoor Spaces Available

POWER REQUIREMENTS: Total number of 110 V (         ) 220V (      )   Amperage needed (_________)

Please note that there is a limited number of plug-ins available and will be on a first come first reserved basis.  All others will be required to provide their own power source.

SIGNATURE: ________________________________________

DATE: ____________________