Type Full Name :
Sign With Hand
Phone # *
State *
Out of State
Unit
ZIP
Retail Food Details
Registration Type *
Name of Establishment
First Name *
State
Are foods prepared at another location? * If so, provide details below
Property Address
Business Name *
Last Name *
Address
ZIP *
If establishment is owned by an out of state entity, please provide details.
ZIP
Address *
Contact Person
Fee Schedule
Contact Number
Establishment provides catering or delivery? *
City
Phone # *
Amount Due
{[CNAME]}
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}
Certification
Documents
Applicant Signature *
Retail Food Owner Details
Address
City, State, ZIP
Description of goods to be sold *
City
Trading As
State
  • Two passport sized pictures of each person selling food
  • Proof of insurance Accord Form
    • Personal Injury - $100,000 per person
    • Personal Injury - $300,000 per occurrence
    • Property Damage - $50,000
  • Board of Health "Satisfactory" Inspection Certificate
    • (call to arrange for inspection 732-341-9700 x 7475)
  • Permission letter from the property owner where you are selling from. The property must be at least 500' from an existing food store or food vendor. Does not apply to ice cream vendors traveling on roadways.
City *
Please attach any supporting documents
Email *
{[PNAME]}
Begin typing Address and select from the populated drop-down *
Regional Office Name