Pop-up Application Form Pop-up Application Form : South Melbourne MarketTrading Name*ABNCompany Name*First Name*Last Name*Email* Contact Number*WebsiteBusiness Address*Facebook Page (insert link)Copy and paste full URL eg: http://www.facebook.com/southmelbournemarketInstagram AccountCopy and paste full URL eg: http://instagram.com/southmelbournemarketTwitter AccountCopy and paste full URL eg: http://twitter.com/sthmelbmarketAttach photo of your ID*Accepted file types: jpg, gif, png, pdf, jpeg.(Format: jpg, png, gif, Size: 10mb max).Please note this process: After your application has been submitted, it will be reviewed and you will be notified of the outcome. If your application is approved, our team will be in contact to discuss potential pop up dates. Payment will only be processed once the application is approved and the dates confirmed and agreed to. If your application is not approved, payment will not be processed.Credit Card*American ExpressMasterCardVisa Card Number Month010203040506070809101112 Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 Expiration Date Security Code Cardholder Name Card payments incur a surcharge to recover merchant fees charged to Council by financial institutions. Visa / Mastercard: 1.16% Amex: 0.65% Eftpos / Debit: 0.59%Terms & Conditions* I agree to give indemnity as outlined in the Terms & Conditions for the period of occupancy to the Port Phillip City Council. I have read and agreed to the Terms & Conditions and Market Rules.E Signature RequiredFull Name*Date* DD MM YYYY This iframe contains the logic required to handle Ajax powered Gravity Forms.