Farmers Market Reservation Form

Butler City Building: 140 West North Street Butler, PA, 16001-5298

Phone: (724) 285-4124 Fax: (724) 285-6880 Emergency: Call 9-1-1

LICENSE FOR USE OF THE FARMER’S MARKET
CITY OF BUTLER, BUTLER COUNTY, PENNSYLVANIA

Contact Person :(Required)

Phone(Required)

Purpose / Event to be held:

Date Needed:(Required)

Time Needed:

Beginning:

Time Needed:(Required)

Ending:

CANCELLATION REQUESTS MUST BE MADE IN WRITING AND AT LEAST THIRTY (30) DAYS BEFORE THE EVENT TO RECEIVE A REFUND.

This License is provided by the City of Butler under and subject to the terms set forth on the reverse side of this License Agreement.

I acknowledge that I have read the terms set forth on the reverse side of this License Agreement and I agree to abide by said terms.

Responsible Party (Signature)

Untitled

(Print Name)

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