Stall Holders Application Form

First Name (required)

Last Name (required)

Mobile Number

Your Email (required)

Street Address

Town/Suburb

Postcode

Do you have food licenses? Please bring to event to be sighted? (if relevant) (please select)
YesNo

Attach your food license here:

Describe the product/s you wish to sell at your stall

Business Name (required)

ABN (Australia Business Number)

Website

Social Network Sites (e.g. Facebook, Twitter if applicable)

If you are selling food please list the food and prices below

Public Liability Insurance - Name of Company *

You MUST have Public Liability Insurance with $10,000,000 cover minimum.

Public Liability Insurance Policy Number – Please bring to the event to be sighted *

Public Liability Insurance Policy Date Expiration

Attach your Public Liablility Certifcate here:

Describe what space you require and what the layout will be. *

Do you have your own power? (please select)
YesNo

Get in Touch

We welcome enquiries about Market Stores at Music in the Mulga

David and Carmel Meurant
Wandilla Station
1508 Pitherty Road, Eulo Qld

Phone: 07 4655 4065
Email: dcmeurant@bigpond.com