Pageant Vendor Application "*" indicates required fields Company, Organization or Individual Name:Contact Name:*Contact Number*Email Address* Mailing Address: Street Address City State / Province / Region ZIP / Postal Code Website List products and/or services you are requesting to serve, sell, or display. Submit photos of your products and/or servicesDescribeWhat will your photo(s) Drop files here or Select files Max. file size: 300 MB. We'd love to see what your space looks like when you are set up.Insurance:Each concessionaire must provide the Arkansas State Fair with proof of general liability insurance of no less than $1,000,000. Please check the form of insurance you will provide during the Fair. Completing this form does not constitute proof of insurance. Proof of insurance will be required once a contract has been issued. Untitled My Own Carrier Purchase through Bearden Insurance Company (You will be billed $125.00, if accepted) CarrierCertification of Applicant I understand that this form is an application for space only, and is neither a commitment by the applicant nor an offer by the Arkansas State Fair to rent space. I certify all information contained in this application to be true and accurate to the best of my knowledgeVendor Space:* The Arkansas Building Table Top Space (Youth Pageant) $50 Barton (Junior and Fair Queen Finals Weekend) $100 The Arkansas Building (Elite Ms Pageants) $50 Friday and Saturday October 3rd and 4th (Junior and Fair Queen Finals) Saturday October 11th (Youth Pageant) Total Credit Card* American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Date Month Month010203040506070809101112 Year Year20252026202720282029203020312032203320342035203620372038203920402041204220432044 Security Code Cardholder Name SignatureDate MM slash DD slash YYYY Δ