Kitsap Antique Show - History & Heritage 2013
Dealer Application & Reservation
Dealer’s Trade Name  

Dealer’s Name  

Mailing Address  

City   State   Zip  

Telephone Cell Phone  E-mail  

Washington Resale # (UBI)  

Booth Size:
Extra Options:
# Tables:  # Chairs  # Electrical  RV Space: #   Vehicle License #

Please describe in the space below the type of merchandise you will be displaying:

Staff Name Badges: (two badges per Dealer will be provided at no charge)
Please list ALL booth staff, including yourself below…

Dealer’s signature: _____________________________ Date: ______________________

Host’s signature: _________________________________ Date: ________________________

Payment is by check or money order. Please send no cash. Deadline: April 9, 2012

Print this application page, sign & return it, along with your check or money order to:
Sandie Morrison, 1627 Lucero Pl. E, Port Orchard, WA 98366
Total Enclosed: $_______________. Make payable to KCHSPSGS Antique Show.
E-mail: Phone: 360-443-2102 or Ann Northcutt 360-405-1056

SHOW OFFICE USE ONLY Date Rec’d __________ Space # __________