MOBILE FOOD VENDOR PERMIT APPLICATION

"*" indicates required fields

This field is for validation purposes and should be left unchanged.

Business Name:*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Owner’s Name:*

Owner’s Address:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone*

Email*

Information below must be for the actual unit used as the MFPV, not the tow vehicle.

License Plate (State and Numbers)*

Vehicle #*

Vehicle Year*

VIN #*

Make*

Model*

Color*

Type*

Trailor

Truck

Other

Signature of Applicant:*

I understand by typing my name I am using it for my signature, and will act as such.

Date*

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