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Mobile Vending Unit Application
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W10=
*
Name
*
Phone
*
Business name
*
Email
*
Address
*
City
*
State
*
Zip Code
*
Driver's license number
*
CSZ
*
Birth date
*
Products to be vended
*
Proposed days of operation
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
*
Proposed hours of operation
*
Description of mobile unit
*
#1 vehicle make
*
#1 vehicle model
*
#1 vehicle year
*
#1 vehicle VIN
*
#1 vehicle license plate number
*
#2 vehicle make
*
#2 vehicle model
*
#2 vehicle year
*
#2 vehicle VIN
*
#2 vehicle license plate number
*
Vending location #1 street address
*
Location #1 owner name
*
Location #1 owner's phone
*
Location #1 owner's address
*
Location #1 owner's city
*
Location #1 owner's state
*
Location #1 owner's zip code
*
Location #1 owner's email
*
Location #1 is within 200 feet of a restaurant
Yes
No
*
Location #1 is within 1,000 feet of a city special event.
Yes
No
*
Vending location #2 street address
*
Location #2 owner's name
*
Location #2 owner's phone
*
Location #2 owner's address
*
Location #2 owner's city
*
Location #2 owner's state
*
Location #2 owner's zip code
*
Location #2 owner's email
Location #2 is within 200 feet of a restaurant
Yes
No
Location #2 is within 1,000 feet of a city special event
Yes
No
*
Today's date
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