Staten Island Mall Vendor Application
Avoid delays and inconveniences.
· Print clearly and answer every item.
· If something does not apply to you fill in the answer by writing N/A.
· Please do not submit this Application without accompanying payment.
My Company Name______________________________________________________________
Items I sell ________________________________________________________________
New York State Sales Tax #____________________________________
Best Phone #(s) To Reach Me (______) _________________ (______)
Overnight Vehicle make model color License Plate #
This payment of $______________
is for the following Show Dates ______________________
I am requesting to be placed in the following location __________________________________
I am requesting (circle one please) 1 space 1 ½ spaces 2 spaces.
Payments made by cash, check or money orders are not subject to any additional fees.
Checks and money orders payable and mailed to AlansFair, Inc. PO Box 431 Point Lookout NY 11569
Payments made by Credit or Debit cards are subject to a 4% processing fee.
Card #________________________________ Exp Date___________ Sec Code_____ Zip Code________
To pay online log onto www.nassaucountyfairs.com for the ONLINE VENDOR APPLICATION.
If you are not paying online through our website then you may mail, fax, or email the completed Vendor Application along with a check or money order.
You may fill in the Credit or Debit Card information above and fax the completed Vendor Application to 516-442-3578.
You may fill in the Credit or Debit Card information above and email the completed Vendor Application to email@example.com
Please call 516-442-6000 if you have any questions.