Please fill in the requested information, sign or have a legal representative sign and return this form to Leonardo’s Coffeehouse (159 N. 4th Street), mail to PO Box 772, Steubenville OH or email to
steubenvillehellbenders@gmail.com. Please include a copy of your up to date food permit (if you are a Cottage Food Operation per Chapter 3715 Ohio Revised Code, this does not apply). Be sure to retain a copy of the form for your records. Make checks payable to the Harmonium Project.