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2. 
4. City of Middleton Mobile Food Establishment Application

   Pursuant to Middleton General Ordinances 7.01

6. Mobile Food Establishment Application
   Chapter 7 City of Middleton Code of Ordinances
8. License Type*

   1. Annual (includes 1 operator) $100
   2. Single Event (includes 1 operator) $50
9. Have you held a previous license in Middleton?*

   1. Yes
   2. No
11. Additional Food Cart Operators
    Additional Food Cart Operator's License Application

    This license application includes one operator.  For additional food cart operators, each would need to complete a Mobile Food Cart Operator License.   Use this link to direct you to the Operator License Application. 

13. Previous License Number (if applicable)
14. Effective dates
16. List (3) cities in which business was conducted preceding this application*
18. Have you ever had a permit suspended, revoked, or denied in any municipality?*

    1. Yes

    1. No
20. If yes, please list municipality and date
24. Applicant Information
26. First Name*
27. Last Name*
29. Former Name or Aliases
30. Upload Driver's License/State ID*
32. Address1*
34. City*
35. State*
36. Zip*
38. Phone Number*
39. E-mail address*
41. Are you a Wisconsin Resident?*

    1. Yes
    2. No
42. If no, what state are you a permanent resident of and for how long?
46. Arrests and Convictions

    List all offenses for which you have been charged or convicted. This list is to include all felony, misdemeanor, forfeiture, and ordinance violations, including traffic citations. The omission of offenses will result in the denial of your permit. 

    Renewals: Since the filing of your last application, have you been convicted of any offenses for violation of any federal, or state laws, or any ordinances of any county or municipality? 

48. If none, initial here
49. Upload additional page (if necessary)
51. If yes, complete below
53. Year
54. City/State
55. Nature of Offense
57. Year
58. City/State
59. Nature of Offense
61. Year
62. City/State
63. Nature of Offense
67. Business Information
69. Business Name*
70. Phone Number*
72. Address1*
74. City*
75. State*
76. Zip*
78. Description of goods/food to be sold/prepared*
82. Vehicle Information
84. How many vehicles will be operated?*
86. Make*
87. Model*
88. Year*
89. License Plate #*
91. Make
92. Model
93. Year
94. License Plate #
96. Make
97. Model
98. Year
99. License Plate #
103. Sales Locations
105. Is this application associated with a special event permit?*

     1. Yes

     1. No
106. If yes, please list the event contact person and phone number
108. If part of a Special Event, what is the name and date of the event.
110. Will sales be mobile?*

     1. Yes

     1. No
111. Will sales be stationary?*

     1. Yes

     1. No
113. Locations/routes where business will be conducted*
114. Length of time*
116. Mobile Food Operation*

     1. Yes

     1. No

     I understand that I may operate from any space with permission from the property owner (and does not create a traffic hazard) or pursuant to a contract with a special event permittee.  I understand I cannot operate on a public street or ANY City property unless operating as part of a special event.  

120. Please attach the following to your application
122. Valid Food & Beverage License Issued by the State of WI or Dane County Public Health*
124. Photograph (approx 2x2) showing head and shoulders of application*

     Not more than one year old

126. Payment Method*

     1. Online

     Once you hit submit, you will be directed to the credit card processing page.  Y

     No fees for Electronic Check.

     3.5% for Credit Card Payment.

130. I have read and agree with the ordinances of the City of Middleton pertaining to the licensing and regulating of mobile food establishments in the City of Middleton. I agree to abide by these and all other ordinances in the City and the laws of the State of Wisconsin. I affirm that I have made complete and true answers to each question and understand that incomplete or false answers may result in denial or revocation of permit. I authorize a review of and full disclosure of any and all records, files, and reports, which include any police contact as well as arrests. I understand that if this license is not issued, fees that have been paid will not be refunded.
132. I attest that the above information is true and correct and that any false or incomplete information may result in denial of my application.
134. By typing my name below, I understand and agree that this form of electronic signature has the same legal force and effect as a manual signature.
135. Initial here*
137. Please type name as shown on application above*
138. Date*
     Date
Leave This Blank:


140. 1. Receive an email copy of this form.
141. Email address

     This field is not part of the form submission.

142. Submit

* indicates a required field