PA Rally On The River
P O Box 330
Northumberland, PA 17857

(800) 243-1056
(570) 473-8021

Application for Vendor Space            August and/or September, 2010
Vendor Fee: FREE

Applicant Name ____________________________________________

Company or Business Name __________________________________

Website __________________________________________________

Street ____________________________________________________

City __________________________State __________ Zip _________

Tel Number Area (      ) ______________________________________

Fax Number Area (     ) ______________________________________

Items you will be vending _____________________________________

Driver's License Number _____________________________________

Issuing State _______________________________________________

Year and Make of Vehicle _____________________________________

License Plate Tag Number ____________________________________

Applicant Signature _____________________________ Date ________

Mail the application to River and Fun, Inc, 213 Yogi Boulevard, Northumberland, PA 17857 Attention Ron Brown