VENDOR SPACE APPLICATION & CONTRACT


Instructions

Complete all sections of this application. Payment must be submitted via credit card using this form.

COMPANY INFORMATION
Company Name:
Contact Name:
Title:
Marketing Contact:
Company Address:
City:   State:   Zip:
Phone Number:
Fax Number:
Email Address:
Web Site:
   
I am a: MBNA Member    MBNA Non-Member
 
BOOTH INFORMATION
6' Table Rates: $200 each
Total Number of tables Requested:
 
Sponsorships: (please select)
Platinum Sponsorship - $2500        Gold Sponsorship - $2000        
Silver Sponsorship - $1500        Bronze Sponsorship - $1000        
 
Sub Total: $
 
Products and/or services to be exhibited:
 
Please select the category that best describes your company:
 
Table Preference
Please indicate your preferred booth number:
1st:       4th:
2nd:   5th:
3rd:      
 
Please avoid (if possible) space assignment adjacent to the following companies:
 
If possible, we would like to be adjacent to:
 
PAYMENT INFORMATION
Total Due for Vendor Space: $
Total Due for Sponsorship: $
Total to Charge: $
 
Credit Card Type: Visa    MasterCard    American Express
Credit Card Number:
Expiration Date:
Name on Card:
 
 
 
Direct questions and/or payment to:
MBNA
136 South Keowee Street
Dayton, Ohio 45402
Phone: 800-233-4472
Fax: 937-222-5794
info@monumentbuilders.org