Mount Pleasant
Farmers Market Inc.
132 Melrose St
Mount Pleasant 5235
p 0418301121
e. [email protected]
w. www.mpfm.org.au
STALLHOLDER APPLICATION FORM: PRIMARY PRODUCER
I would like to apply for a stall site at the Mount Pleasant Farmers Market.
Date:…………………….
Please note: this application does not guarantee that you will be offered a stall site nor does it commit
you to taking up an offer of a stall site.
COMPANY DETAILS
Name of stall applicant:……………………………………………………………………………………………………….
Registered business name:…………………………………………………………....ABN:………………………………
Property address:……………………………………………………………………………………………………………..
Mailing address:……………………………………………………………………………………………………………….
Phone:…………………………………………………………………..Mobile:……………………………………………..
Fax:………………………………………...Email:……………………………………………………………………………
DESCRIPTION OF PRODUCT
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AVAILABILITY OF PRODUCE OFFERED (please specify available months)
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Organic
Certified Organic
Bio-dynamic
Integrated Pest Management System
Other Quality Assurance (Please specify)……………………………………………………………………………….
DETAILS OF PROPOSED STALL REQUIRMENTS
Every week Every fortnight Other timing (please specify)…………………………………………………..
Electricity
Other requirements ………………………………………………………………………………….
Standard site (9 square metres)
1.5 size site
Double size site
Shared site
Please provide a brief description of your proposed stall. Applicants are encouraged to attach sketches and /or
photographs with this form. Also include verification of your farm’s biodynamic or organic status, or certification
for your product if relevant, insurance certificate of currency, and local council licence/registration for food
production and sale/local council food safety assessment certificate (if process is underway but not complete,
please indicate).
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PRIMARY PRODUCER APPLICATION FORM VERSION 1.4 DATE 25.8.2015
Mount Pleasant
Farmers Market Inc.
132 Melrose St
Mount Pleasant 5235
p 0418301121
e. [email protected]
w. www.mpfm.org.au
Applicants please note the following conditions:
On acceptance of a site offered by the Management of the Mount Pleasant Farmers Market you will be required
to enter into a mutual agreement as set out in the Mount Pleasant Farmers Market Rules and Regulations.
These will be forwarded to you on confirmation of your participation in the Market.
The Mount Pleasant Farmers Market, at all times, reserves the right to refuse any of the listed products for sale
at the Market or to not accept this application.
STALLHOLDER COMMITMENT
I , ..……………………………………………………………………………………………………………………………
Have read and understood my rights and obligations as a stallholder at the Mount Pleasant Farmers Market as
identified in the document “Mount Pleasant Farmers Market Stallholder Rules and Responsibilities 2015-16 ”
I agree to abide by the rules and responsibilities as they are written.
I understand that my right to trade may be refused if I do not abide by them.
I understand that this application is accepted by MPFM at the discretion of the Management Board.
I hereby declare that the information provided in this application is correct and that I have not knowingly used
any GMO’s in my products.
I declare that I will not engage in the reselling of any product offered for sale on my stall unless specifically
agreed by the Management Board.
I agree that I, on the behalf of
(TRADING ENTITY) ……………………….……………………………………………….……………………………...
Will indemnify to the extent permitted by law the MPFM Inc from any damage, expenses or liability arising from
any injury or damages to any person that occurs either in or arising out of the occupancy of the stall site or any
thing connected with such occupancy.
Signed………………………………………………………………………………………………………………………..
On behalf of (company) : ….....……………………………………………………………………………………………
Position (i.e. Manager/Owner) : …………………………………………………………………………………………..
Date………………………………
Please post this form to Mount Pleasant Farmers Market,
132 Melrose St, Mount Pleasant 5235 or fax to 08 8568 2699.
PRIMARY PRODUCER APPLICATION FORM VERSION 1.4 DATE 25.8.2015