Business Information Date:
_____________
Business Name:
_____________________________________________________________
Owners Name:
_____________________________
Emergency Contact:
________________
Business Phone:
___________________________
Email:
____________________________
Mailing Address:
____________________________________________________________
Business Type: (Check all that apply)
_______
Catering Only
_______
*Concessionaire/Event Vendor
*Concessionaire/Event Vendors are required
to list where they will be doing business in Arkadelphia
Business Association: (Check one)
____ Corporation
____ LLC (Limited Liability Company)
_____General Partnership
_____ Sole Proprietorship
Business Federal ID# or Social Security #
_________________________________________
Driver’s License#
_________________________________
State issued:
__________________
Arkansas State Sales Tax#
_______________________________________________________
Personal Information
Applicant Name:
______________________________________________________________
Applicant Address:
____________________________________________________________
Applicant Phone:
___________________
Applicant Email:
____________________________
Applicant DL#
____________________
State issued:
_________________________________
Signature:
_______________________
Printed Name:
_________________________________
OFFICE USE ONLY
Approved by:
_______________
Date:
________________
_______________________________________________________________________
20_____
City of Arkadelphia
Annual Mobile Food Permit Application
(Expires December 31
st
of each year)
Submit
click to sign
signature
click to edit
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