Name:...............................................................................................................
Phone:
.............................
Business
Name...........................................................................................................................................
NM CRS Number
....................................................................................................................................
Mailing
Address.........................................................................................................................................
City, State and Zip
Code.............................................................................................................................
Email Address
............................................................................................................................................
Number of 10 x 10 needed?
................................................................................................($30.00
each)
Goods being sold
.......................................................................................................................................
..................................................................................................................................................................
Signature of responsible party
....................................................................................................................
Please make checks or money orders
payable to:
H.O.M.E.
C/O George Tippin
P.O. Box 1324, Capitan NM 88316
Fees are nonrefundable
For more information call 505-354-7021
or Email lincolncountyevents@yahoo.com