Vendor Information

Vendor states a person who has passed the Temporary Food Permit & Food Safety Training will be available on-site.

Business Name/Entity (if applicable)

First Name

Last Name

Address
Street address (Number, Street Name, Type of Street)

City

State

Zip Code

Phone Number

Email Address

Name of the Company or Organization

IRS Tax ID Number
Provide the IRS Tax ID Number

Name of Event

Start Date of Event
Please select the start date(s) of event. A separate permit is required for non-consecutive days.

Start Time of Event
Please enter the start time of the event.
1 2 3 4 5 6 7 8 9 10 11 12 : 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 AM PM

End Date of Event
Please select the end date(s) of event. A separate permit is required for non-consecutive days.

End Time of Event
Please enter the end time of the event.
1 2 3 4 5 6 7 8 9 10 11 12 : 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 AM PM

What is your Booth Name in the Food Event?

Are you selling food for profit?
Yes
No

Do you live in a low-income low-access census tract AND are selling food in a LILA census tract?
Yes
No

Is the food nutritious?
Yes
No

What kind of food do you produce?
- select - Cottage Food Low Risk Other

List of food items to be sold or given away (Do not include canned or bottle water, soda, packaged item such as mustard, catsup, potato chips etc.)

ALL foods listed above MUST be prepared at the permitted location or transported from a permitted facility. Provide name and location of permitted facility if different from event location.