Health and Wellness Block Party

August 8th

11am - 6pm

807 Wallace Ave.

Wilkinsburg, PA 15221

Health and Wellness Block Party Vendor Application
* Tax ID
* Type of Company
* Company name (as shown on federal tax form)
   DBA name (doing business as)
* Mailing address
* City
* State
* Zip code
* Contact person
* Phone number (xxx-xxx-xxxx)
* Email address
* Fax number (xxx-xxx-xxxx)
   Company website
* Company desription (products/services offered, target audience)
* How will you pay your vendor fee?
* Are you currently, or have you ever been employed by Hosanna House, Inc.?Yes No
   If so, what was your position and employment dates?
* How did you hear about this event?
   If other, please specify
* Please type your name for e-signature
* Today's date
* Enter number below to submit form

Contact

For more information, please contact us at 412-342-1286 or wellness@hosannahouse.org.