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. S)))))))))))))))))))))))))Q S)))))))))))))))))))))))))))))))Q DATE SIGNATURE OF VENDOR S)))))))))))))))))))))))))Q S)))))))))))))))))))))))))))))))Q DATE DIRECTOR OR DESIGNEE VENDING FACILITY PROGRAM