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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. Have you held a previous license in Middleton?*

   1. Yes

   1. No
9. Previous License Number (if applicable)
10. Effective dates
14. Applicant Information
16. First Name*
17. Last Name*
19. Former Name or Aliases
20. Upload Driver's License/State ID*
22. Address1*
24. City*
25. State*
26. Zip*
28. Phone Number*
29. E-mail address*
31. Are you a Wisconsin Resident?*

    1. Yes
    2. No
32. If no, what state are you a permanent resident of and for how long?
36. 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? 

38. If none, initial here
39. Upload additional page (if necessary)
41. If yes, complete below
43. Year
44. City/State
45. Nature of Offense
47. Year
48. City/State
49. Nature of Offense
51. Year
52. City/State
53. Nature of Offense
57. Business Information
59. Business Name*
60. Phone Number*
62. Contact Name*
64. Address1*
66. City*
67. State*
68. Zip*
70. Please attach the following to your application
72. Photograph (approx 2x2) showing head and shoulders of application*

    Not more than one year old

74. 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.

78. 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.
80. 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.
81. Initial here*
83. Please type name as shown on application above*
84. Date*
    Date
Leave This Blank:


86. 1. Receive an email copy of this form.
87. Email address

    This field is not part of the form submission.

88. Submit

* indicates a required field