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
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
Type Full Name :
Sign With Hand
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