Type Full Name :
Sign With Hand
1200 Mountain Avenue
Middlesex, NJ 08846
(732) 356-7400
Borough of
Establishment Information
Establishment Type
How do you intend to pay? ***If applicant chooses to "Pay Now" via Credit Card on Line, there is a 3 % convenience Fee.
City *
Email *
Emergency Phone #
State *
Fees Total
Mercantile License
Late Fees
Application Type *
State *
License expires February 28th of every year.
Late fees will be applied if application is an Annual renewal and application is submitted after April 1st. Fee is subject to proration if application type is new and it is applied for after September 1st.
Ownership Type *
Phone # *
Emergency Contact
Applicant Signature *
City *
First Name *
Phone # *
Address *
# of Days (only for Temporary)
Will Food Be Served? *
Address *
Business Name *
Last Name *
Emergency Contact Information
Emergency Email
Amount Due
License Fee
A License will NOT BE issued until approved by the Health Department.
Owner Information
Establishment Type *
Certified Food Safety Professional
CC Fee
Category *
Preferred delivery method for license
# of Employees
Specify Address where establishment resides *