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Renewal
New
Ice Cream
Hot Dog
Other
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Type Full Name :
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Phone #
*
Food Truck License Plate #
*
State
*
Out of State
Mobile Food Details
Registration Type
*
Name of Establishment
First Name
*
Are foods prepared at another location?
*
If so, provide details below
Food Truck Type
*
Is the Owner the only employee?
*
If No, provide details of every employee below
Business Name
*
Last Name
*
Address
ZIP
*
If establishment is owned by an out of state entity, please provide details.
ZIP
Food Truck Model
*
Address
*
Contact Person
Fee Schedule
Contact Number
Establishment provides catering or delivery?
*
City
Phone #
*
Amount Due
{[CNAME]}
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}
Food Truck Make
*
Certification
Required Documents
Employee(s)
Applicant Signature
*
Mobile Food Owner Details
Address
City, State, ZIP
Description of goods to be sold
*
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
*
Email
*
{[PNAME]}
Regional Office Name
Phone #
Email
ZIP
City
First Name
Address
State
Employee Details
Last Name
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