* = Required fields

COMPANY OR GROUP NAME:*
ORGANIZATION TYPE:*	-- Choose One -- Unrecognized Student Organization For Profit Group Non-Profit Group
CONTACT FIRST NAME:*
CONTACT LAST NAME:*
PHONE NUMBER:*
FAX NUMBER:
EMAIL:*
BILLING ADDRESS:*
CITY:*
STATE:*
ZIP CODE:*
NAME OF ON-SITE REPRESENTATIVE:*
PRODUCT DESCRIPTION:*
IS ELECTRICITY NEEDED?	YesNo	Electricity is provided at the discretion of Chapman University. Any necessary extension cords are the responsibility of the vendor or student organization.
SPACES NEEDED:	-- Choose One -- 1 2 3 4 5	Spaces are billed at a rate of $40 a day per space for outside vendors and $20 a day per space for unrecognized student groups. A space includes one 6 foot table and two chairs.
DATE(S) REQUESTED:

Each Applicant organization must provide a current certificate of insurance naming Chapman University as an Additional Insured. For more information on these requirements: Certificate of Insurance: Indemnity and Insurance Requirements (PDF)

If we have a current copy of your insurance and your business license (if applicable), you do not need to turn those in each time. If you have not previously provided this information, or if the information we have on file is out-of-date, please attach a current copy. In the alternative, you may fax your information to: 714.997.6852

UPLOAD DOCUMENT: