Required fields are marked with asterisks (*)

Mobile Food Vendor's Licence Application

By-law Number 102-2008

(Amended by By-law 120-2009, November 16, 2009)

I acknowledge that to receive my licence I must obtain approval from these depts (select all):

Fire Dept: 519-941-3083 Ext. 6530 or 6531

Health Unit: 1-800-265-7293 Ext. 4753

Date of Application:

Full Name of Applicant:

Email:

Phone Number:

Street Address of Owner:

Postal Code:

Name of Restaurant:

Location of Restaurant:

Restaurant Owner Name (if different from applicant):

Mailing Address (if different from above):

Are you a Resident or Non-Resident?

Type of Business:

Special Event Vendor - One Day Only ($120 / $144)

Special Fundraising / Charity Event - Administration Fee ($25)

Food or Hot/Dog Cart ($500 / $600)

Chip Truck ($500 / $600)

Mobile Lunch Truck ($500 / $600)

Ice Cream Truck ($500 / $600)

Ice Cream Bicycle ($100 / $120)

Refreshment Stand / Truck ($500 / $600)

List Food Items to be Sold:

Location(s) of Mobile Site:

Municipal Park or Facility

Outside Central Business District

Central Business District - Northwest corner of First Street & Broadway

Central Business District - Northwest corner of Second Street & Broadway

Central Business District - Southside of Broadway, between 114 & 136 Broadway

Private Property

Please add your location details:

Please attach your business insurance:

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Allowed extensions pdf, doc, docx, xls, xlsx, jpg, jpeg, gif, png, tif

How would you like to receive your licence?

I would like it mailed (please allow for 5 business days, excluding Canada Post delivery time).

I will pick it up at Town Hall (you will be contacted when your licence is ready).

How would you like to pay?

I will pay online after my approvals and submission have been successful.

I will pay in person.

Consent:

I give my consent for the use and/or disclosure of contact information (telephone number, email address, mailing address) to Town of Orangeville representatives for the purpose of business outreach communications.

Personal information collected on this form is collected pursuant to Section 151, Municipal Act S.O. 2001, c.25, as amended, and will be used for the purpose of processing your application. Questions about this collection should be directed to the Admin/Licensing Assistant, 87 Broadway, Orangeville, ON L9W 1K1, 519-941-0440, Ext. 2239.

The undersigned hereby releases the Corporation of the Town of Orangeville from any or all claims for damages which may arise in the carrying on of business within the Municipality under which the undersigned is licensed by the Municipality to do so.

I certify that the information contained herein is true and correct.

Yes

Signature:

Clear

Employee Wellness Fair

Mobile Food Vendor's Licence Application

Stay Connected with Orangeville

Employee Wellness Fair

Mobile Food Vendor's Licence Application

Stay Connected with Orangeville

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