{[PNAME]} Application
Phone #

" Temporary Retail Food License (PDF) "

Address
Applicant Information
Email
ZIP
State
{[ADDR]}
{[CITY]}, {[STATE]} {[ZIP]}
{[APHONE]}
{[AWEBSITE]}
Name
City
  • Contacts
  • Food
  • Workers
  • Attachments & Fees
  • Certification
Establishment Information
State
Phone #
Email
City
Event Information
Event Name
Non-Profit?
Event Coordinator Information
ZIP
Event End Date and Time
Will there be a Food Truck?
# of Days
Name
Phone #
Location of the Event
Address
Email
Event Start Date and Time
Name
Describe how each food will be transported to the Event
Be specific
Grill/Oven
City
Method for keeping hot foods at 135 °F or above:
N/A
ZIP
N/A
Case Covers
Method For keeping cold foods at 41 °F or below:
Facility Name
N/A
Food Source and Transportation Information
Other
Steam Table
Sneeze Guard
State
Freezer
Sternos
During the Event Information
Other
Method used to protect foods on display:
Preparation of food in a “home kitchen” is strictly forbidden without a Cottage Permit from the NJDOH. If you have a Cottage Permit, a copy must be included with application.
Frozen Food
Hot Food
Other
Ice Chest
Cold Food
Total # of Food and Beverage Items
List all food and beverage items to be prepared and served
Will all Foods Be Prepared at The TFE Site?
Address
Food Information
Off-Site Facility Information
Refrigerator
Food Purchased From
Total # of Workers
Workers Information
Record the names, shifts and the assigned duties of all Temporary Food Establishment workers (paid & volunteer) that will be working the event
# of Paid Workers
# of Volunteer Workers
A copy of your ServSafe certificate (if applicable).
Preparation of food in a “home kitchen” is strictly forbidden without a Cottage Permit from the NJDOH. If you have a Cottage Permit, a copy must be included with application.
For Public Non-Profit Organizations, If asked, be prepared to provide our office with a copy of an IRS 501(c)(3) letter to verify your non-profit classification.
Event Days Fees
From 1 to 2 Days $50
From 3 to 4 Days $100
A copy of your Sanitary Inspection Certificate.
License Fee
A menu of the food to be served.
License Fee
A copy of your food business license from the township where you are located.
Please Confirm The Following Are Attached
All food trucks must provide a copy of their most recent Health Department inspection report form the town where they are based in.
Type Full Name :
Sign With Hand
Certification
Do you agree to the above Statement?
Applicant Signature
I hereby certify that all the above listed information is correct and I fully understand that any deviation from the above without prior permission from the Montgomery Township Health Department may nullify this permit.
Please be advised that application fees are non-refundable.