{[PNAME]} Application
Phone #
Address

Application must be submitted a minimum of 7 days prior to the event.

Applicant Information
Email
ZIP
State
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}
Name
City
  • Contacts
  • Food
  • Workers
  • Attachments & Fees
  • Certification
Establishment Information
State
Phone #
Email
City
Event Information
Event Name
Non-Profit?
Event Coordinator Information
ZIP
Event End Date and Time
Will there be a Food Truck?
# of Days
Name
Phone #
Location of the Event
Address
Email
Event Start Date and Time
Name
Describe how each food will be transported to the Event
Be specific
Grill/Oven
City
Method for keeping hot foods at 135 °F or above:
N/A
ZIP
N/A
Case Covers
Method For keeping cold foods at 41 °F or below:
Facility Name
N/A
Food Source and Transportation Information
Other
Steam Table
Sneeze Guard
State
Freezer
Sternos
During the Event Information
Other
Method used to protect foods on display:
Preparation of food in a “home kitchen” is strictly forbidden without a Cottage Permit from the NJDOH. If you have a Cottage Permit, a copy must be included with application.
Frozen Food
Hot Food
Other
Ice Chest
Cold Food
Total # of Food and Beverage Items
List all food and beverage items to be prepared and served
Will all Foods Be Prepared at The TFE Site?
Address
Food Information
Off-Site Facility Information
Refrigerator
Food Purchased From
Total # of Workers
Workers Information
Record the names, shifts and the assigned duties of all Temporary Food Establishment workers (paid & volunteer) that will be working the event
# of Paid Workers
# of Volunteer Workers
A copy of your ServSafe certificate (if applicable).
Preparation of food in a “home kitchen” is strictly forbidden without a Cottage Permit from the NJDOH. If you have a Cottage Permit, a copy must be included with application.
For Public Non-Profit Organizations, If asked, be prepared to provide our office with a copy of an IRS 501(c)(3) letter to verify your non-profit classification.
Event Days Fees
From 1 to 2 Days $50
From 3 to 4 Days $100
A copy of your Sanitary Inspection Certificate.
License Fee
A menu of the food to be served.
License Fee
A copy of your food business license from the township where you are located.
Please Confirm The Following Are Attached
All food trucks must provide a copy of their most recent Health Department inspection report form the town where they are based in.
Type Full Name :
Sign With Hand
Certification
Do you agree to the above Statement?
Applicant Signature
If you are cooking with propane or any open flame you need to contact Montgomery Fire Prevention for a separate permit at: (908) 359-8211 ext. 2230
I hereby certify that all the above listed information is correct and I fully understand that any deviation from the above without prior permission from the Montgomery Township Health Department may nullify this permit.
Please be advised that application fees are non-refundable.