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2. 
3. City of Middleton Mobile Food Establishment - Operator Application

   Pursuant to Middleton General Ordinances 7.01

5. Mobile Food Establishment - Operator Application
   Chapter 7 City of Middleton Code of Ordinances
7. Note: This application is for Extra Food Cart Operators only. Please complete the Mobile Food Establishment Application for the Food Cart itself.
   Mobile Food Cart Application
9. Have you held a previous license in Middleton?*

   1. Yes

   1. No
11. Previous License Number (if applicable)
12. Effective dates
16. Applicant Information
18. First Name*
19. Last Name*
21. Former Name or Aliases
22. Upload Driver's License/State ID*
24. Address1*
26. City*
27. State*
28. Zip*
30. Phone Number*
31. E-mail address*
33. Are you a Wisconsin Resident?*

    1. Yes
    2. No
34. If no, what state are you a permanent resident of and for how long?
38. 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? 

40. If none, initial here
41. Upload additional page (if necessary)
43. If yes, complete below
45. Year
46. City/State
47. Nature of Offense
49. Year
50. City/State
51. Nature of Offense
53. Year
54. City/State
55. Nature of Offense
59. Business Information
61. Business Name*
62. Phone Number*
64. Contact Name*
66. Address1*
68. City*
69. State*
70. Zip*
72. Please attach the following to your application
74. Photograph (approx 2x2) showing head and shoulders of application*

    Not more than one year old

76. Payment Method (see descriptions below)*

    1. Payment included with Mobile Food Application
    2. Mailing Check

    If this operator license payment was made at the time of the mobile food application, select "Payment included with Moblie Food Application".  

    If this operator license application is being made after the initial Food Cart Permit Application was submitted and paid for, you can mail a check to our office at 7426 Hubbard Avenue, Middleton, WI  53562, or contact the City Clerk at lburns@cityofmiddleton.us to make payment online.

80. 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.
82. 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.
83. Initial here*
85. Please type name as shown on application above*
86. Date*
    Date
Leave This Blank:


88. 1. Receive an email copy of this form.
89. Email address

    This field is not part of the form submission.

90. Submit

* indicates a required field