Type Full Name :
Sign With Hand
Phone # *
ZIP
Last Name *
State *
Signature Date and Time *
Mobile Retail Food
Unit
ZIP
Retail Food Details
Registration Type *
Please print the person(s) who will be responsible for maintaining food safety for this establishment. The Montgomery Township Board of Health Code requires there be at least one employee on the premises, a minimum of 4 hours each 8 hour work period, that possesses a “NEW JERSEY CERTIFIED FOOD MANAGER’S CERTIFICATE.” A copy of each employee’s most current certificate must be on file with this Department.
First Name *
City
Establishment served by Grease Trap? *
State
Mobile Retail Food Establishments -Is the food prepared at another location? If so, provide details in the "Mobile Retail Food" section below.
Property Address
Business Owner same as Applicant *
Business Name *
State *
Last Name *
Address
ZIP *
ZIP *
Work Schedule *
Square Feet *
Email *
Please list the name and location of your commissary or base of operation: (this would be where the transportation vehicle returns regularly for such things as: restocking food, refilling water tanks, vehicle and equipment cleaning, etc)
Certified Food Manager #1 *
Applicant Details
Month/Year of Last Training
Address *
License Plate # of Vehicle(s) used
Fee Schedule
Work Schedule
Phone #
Establishment provides catering or delivery? *
Emergency / Cell Phone # *
Amount Due
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ALL food sold for public consumption must be prepared at or purchased from an approved/licensed facility. Preparation of food in a “home kitchen” is strictly forbidden.
Certification
Attachments
Address *
Applicant Signature *
Retail Food Owner Details
State
City
Trading As
Phone # *
Seating Capacity *
Certified Food Manager
  • 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 *
Restaurants/Establishments With Seating
Seating Capacity – 1 to 50: $150.00
Seating Capacity – 51 to 100: $250.00
Seating Capacity – 101 & over: $350.00

Other than Restaurants (Supermarket, Bakery etc.)
0 – 3500 square feet - $150.00
3501 – 5000 square feet - $250.00
5001 – 10,000 square feet - $350.00
Over 10,000 square feet - $650.00

Pre-packaged Foods only - $65.00

Mobile Retail Food - $150.00

Annual Grease Trap Registration - $25.00

A $15.00 per month late fee will automatically be added to your licensing fee beginning February 1st

City *
Attach a copy of each employee’s most current “NEW JERSEY CERTIFIED FOOD MANAGER’S CERTIFICATE.”.
Proof of Serv-Safe (or equivalent ) Food Safety Training (If applicable)
Proof of Grease Trap Pumping (If applicable)
Month/Year of Last Training *
Email *
Retail Food License Application
Food Establishment Type *
Certified Food Manager #2
First Name *
Begin typing Address and select from the populated drop-down *
Name