Student Organization / University Department:

Registered Student Organization: Yes   No

Contact:

Phone:

Email:

Address:

City:

State:

ZIP:

Artwork/Product Description:

Product will be: (Check all that apply)

Sold to the general public

Given to members only

Sold to members only

Other 

If product is sold, proceeds will be used for:

Organization/Department Fund-Raiser

Given to a Charitable Organization

Special Event (Title) (Date)

Other

Vendor Information

Name of licensed vendor:

Contact:

Phone:

Email:

Please state product color(s) , , ,