111 CMR, § 3.19 - Appendix 1: Form

MASSACHUSETTS COMMISSION FOR THE BLIND

VENDING FACILITY PROGRAM

SELECTION AGREEMENT

I __________, holder of a valid license to operate a vending facility (wet stand, dry stand, vending machine operation, cafeteria) hereby accept selection to operate the vending facility located at and agree that on or about I shall begin operation of that facility in full compliance with the Vending Facility Program Regulations, with the permit, and with all other legal requirements.

I also hereby give notice of resignation as operator of the vending facility located at _______ and agree that I shall terminate operation of that facility on or about ________. On that date I will have either paid or completed arrangements to pay all outstanding bills.

I understand that effective on delivery this notice of resignation is final and that I cannot revoke it without the written consent of the Vending Program Director.

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DATE SIGNATURE OF VENDOR

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DATE DIRECTOR OR DESIGNEE

VENDING FACILITY PROGRAM

Notes

111 CMR, § 3.19