Online Form - Pacific Northwest Historics

Form Deadline, June 1
Yes! We are proud to support the SOVREN Guild of Seattle Children's Hospital and the Pacific Northwest Historic Vintage
Auto Races which will be held at Pacific Raceways.
Vendor Booth 10x10 space including tent
Additional 10x10 space including tent
Tented vendor space is to include a 10x10 tent with four sides, one eight-foot table with plastic skirt and table cloth, two chairs, a fire
extinguisher as required by King County Fire Marshall.
Vendor 10x10 space only
Additional 10x10 space only
Space only vendor must bring a fire extinguisher as required by King County fire Marshall
Prices above to include: six – one day admission to event, two tickets to Saturday dinner/auction and two tickets to our
Sunday breakfast.
We regret that we are unable to participate as a vendor this year.
We are interested in providing "in-kind" donations (goods and/or services)
COMPANY (as it should appear in print): ____________________________________________________________________
CONTACT NAME: ________________________________
Title: _____________________________________________
ADDRESS: ______________________________________
City: ___________________ State: _______ Zip: __________
PHONE: ________________________________________
Email: _____________________________________________
Washington State UBI number_________________________
Vendor Booth Size: __________________________________
Please confirm my participation - $_________ is enclosed
To pay via credit card:
Charge type (circle) visa
mastercard Amount: _________ V-code: _____
Card Number: _____________________________________________________ Exp. Date: _____________
Card Holder: _________________________________ Address: ___________________________________
City: ________________________________________ State: _______________ Zip: __________________
Completed forms can be sent to Jerri Chase:
Email: [email protected]
Questions: 206-406-7790
Payments can be sent to:
(please include a copy of this complete form)
Jerri Chase
16280 Mountain View Road, Mount Vernon, Wa 98274
SOVREN Guild, Seattle Children’s Hospital Tax Exempt Number: 94-3164280