Form Center

By signing in or creating an account, some fields will auto-populate with your information.

Annual Mobile Food Registration

  1. OFFICE OF THE TOWNSHIP CLERK

    95 West Veterans Highway

    Jackson, NJ 08527

    (732) 928-1200 | Fax (732)928-4377

  2. APPLICATION FOR ANNUAL MOBILE FOOD REGISTRATION

  3. *MOBILE FOOD LICENSE REGISTRATIONS ARE VALID UNTIL DECEMBER 31st* 

  4. Does this establishment provice catering or delivery?
  5. Are foods prepared at another location?
  6. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  7. Do Not Complete Below

    ***************************************************************************************

    HEALTH OFFICER’S INSPECTION REPORT
    Inspection of the above premises was completed on _____________________ and it is recommended that
    The licensed BE______ NOT BE_____ issued. If recommendation is for non-issuance, attach inspection report. 

                                                                                                       ___________________________________
                                                                                                                                     HEALTH OFFICER 

  8. APPLICATION FOR ANNUAL MOBILE FOOD REGISTRATION

    VENDOR’S REGISTRATIONINFORMATION

  9. Please provide and include the following with this application:(SEE PAGE 3-4

    Certificate of Liability Insurance–Acord form with Jackson Township as additional insured:

    Minimum coverage–Personal Injury $100,000/$300,000 

    Property Damage $50,000

    Copy of Vehicle Registration card and Driver’s license (of all employees) 

    Copy of Ocean County Health Department “Satisfactory” certificate 

    Two (2) 1-inch square photos of each person selling food.

  10. Vehicle Information:
  11. Has the applicant ever had an application to conduct a vending business denied or revoked?
  12. Has the applicant ever been convicted of a crime?
  13. Certificate of Liability Insurance – Acord form with Jackson Township as additional insured:

    Minimum coverage–Personal Injury $100,000/$300,000

    Property Damage $50,000

  14. Electronic Signature Agreement
    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
  15. DO NOT WRITE BELOW-MUNICIPAL USE ONLY

    *************************************************************************************************************************

    CODE ENFORCEMENT APPROVAL _______________________ DATE: _____________________

    FIRE DISTRICT APPROVAL ____________________________ DATE: _____________________

    (Excludes: ice cream trucks) 

    OCEAN COUNTY BOARD OF HEALTH APPROVAL ______________________________________

  16. Leave This Blank:

  17. This field is not part of the form submission.