Imbil Markets Stallholder Application Form Stallholder application form Business / Organisation Name * ABN Name * Name First First Last Last Address * Address Address Address City City State State Postcode Postcode Phone * Mobile Email * Website Date of Stall Public Liability Insurer * (Copy of Insurance Policy to be provided to MVCCI) Upload a copy your Public Liability Policy * Drop a file here or click to upload Choose File Maximum upload size: 134.22MB Policy No: * Expiry Date: * Business / Organization Profile (for promotion purposes – photos welcome) By submitting this form, you agree to the Imbil Town Market Terms and Conditions * Accept I confirm that the above information is true and correct and agree with the Imbil Town Market Terms and Conditions * Accept Copy of my insurance policy and/or license is uploaded to this form * Agree Direct deposit details are listed below. If you are human, leave this field blank. Submit
