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PLC:

a006f8

Agency:

city of new roads

For:

harvest festival booth rental

Phone:

225-638-5360

Address:

211 west main street
new roads, louisiana 70760

*Required Field

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*Name:

Middle:

*Last:

*Business Name:

*Business Address:

*City:

*State:

*Zip:

*Phone Number:

(### - ### - ####)

*Email Address:

Food Vendor:

10 by 10 $500.00

10 by 20 $700.00

Snack Booth 10 by 10 $200.00

Over 20 FT $1000.00

Craft Vendor:

10 by 10 $225

10 by 20 $300

10 by 30 $375

10 by 40 $450

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Payment Amount :

Subtotal:

$0.00

Total:

$0.00

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*First Name:

Middle Initial:

*Last Name:

*Billing Address:

*City:

*State/Province:

*Zip:

*Country:

*Phone Number:

*Credit/Debit Card:

(enter the full card number without any dashes or spaces)

*Expiration Date:

*Card Security Number:

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