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2. 
3. City of Middleton Mobile Food Establishment Application

   Pursuant to Middleton General Ordinances 7.01

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

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

   1. Yes
   2. No
10. 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. 

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

    1. Yes

    1. No
19. If yes, please list municipality and date
23. Applicant Information
25. First Name*
26. Last Name*
28. Former Name or Aliases
29. Upload Driver's License/State ID*
31. Address1*
33. City*
34. State*
35. Zip*
37. Phone Number*
38. E-mail address*
40. Are you a Wisconsin Resident?*

    1. Yes
    2. No
41. If no, what state are you a permanent resident of and for how long?
45. 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? 

47. If none, initial here
48. Upload additional page (if necessary)
50. If yes, complete below
52. Year
53. City/State
54. Nature of Offense
56. Year
57. City/State
58. Nature of Offense
60. Year
61. City/State
62. Nature of Offense
66. Business Information
68. Business Name*
69. Phone Number*
71. Address1*
73. City*
74. State*
75. Zip*
77. Description of goods/food to be sold/prepared*
81. Vehicle Information
83. How many vehicles will be operated?*
85. Make*
86. Model*
87. Year*
88. License Plate #*
90. Make
91. Model
92. Year
93. License Plate #
95. Make
96. Model
97. Year
98. License Plate #
102. Sales Locations
104. Is this application associated with a special event permit?*

     1. Yes

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

     1. Yes

     1. No
110. Will sales be stationary?*

     1. Yes

     1. No
112. Locations/routes where business will be conducted*
113. Length of time*
117. Please attach the following to your application
119. Valid Food & Beverage License Issued by the State of WI or Dane County Public Health*
121. Photograph (approx 2x2) showing head and shoulders of application*

     Not more than one year old

123. Payment Method*

     1. Online
     2. Mailing Check

     Once you hit submit, you will be directed to the credit card processing page.  You may also mail a check to our office at 7426 Hubbard Avenue, Middleton, WI  53562.

127. 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.
129. I attest that the above information is true and correct and that any false or incomplete information may result in denial of my application.
131. 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.
132. Initial here*
134. Please type name as shown on application above*
135. Date*
     Date
Leave This Blank:


137. 1. Receive an email copy of this form.
138. Email address

     This field is not part of the form submission.

139. Submit

* indicates a required field