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Renewed
Not Renewed
New
Request Payment
Paid
Approved
Denied
New
Renewal
Email
Phone #
Please fill out this form entirely.
Application Type
Fax #
Business Details
{[DEP]}
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[PPHONE]}
{[AWEBSITE]}
ZIP
City
Business Name
{[PNAME]}
State
Address
Machine and Business details
Fees, Attachments and Certification
Add Machine(s)
Yes
No
Name
Machine Details
Vending Machine Company Name
Phone #
Business Owner Address Is Mailing Address?
Email
Fax #
Address 2
ZIP
# of Machines
Phone #
Fax #
Contact Person Details
Address
Business Owner Details
Email
City
State
Preferred Mailing Address
Pay Now
Pay Later
Cash
Check
Credit Card
Money Order
Type Full Name :
Sign With Hand
Clear
Done
Preferred Payment Method?
Certification
Attachments
Application Type
Fee
New Aplication
$28 / Machine
Late Fee
$53.00 / Month
Fee
Signature
In making this application, I or we, agree to comply with all of the ordinances of the {[CNAME]}, and the law of the State of New Jersey, covering such establishment. It is further understood that, I or we, will surrender licenses, if granted, to the {[CNAME]} on demand. Expiration date is December 31st of each year. When there is a change in ownership or discontinuance of business, this license must be surrendered to this office.
Application Fee
Yes
No
Machine Details
Are Machine Locations All the same?
Machine Location
Machine Locations Descreption
# of Machines
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Date :
Reference # :
Email :
Fee :
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Reference #
Business Email
Provide the following information to locate the previous's Vending Machine License application.
Once you are finished, press Find My License, from there, you can update any information for the renewal application
Business Name
Business Address