Commercial Vendor Registration

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Business Name

First Name

Last Name

Email

Phone

Street Address

Street Address Line 2

City

Region/State/Province

Postal / Zip code

Street Address Line 2

Do you need Electric Hookups?? If no, type NA.

What will you be selling as a vendor?

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Bob Burdette Center, Inc.

1401 Washington Street West

Charleston, WV 25387