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Mobile Refreshment License Application

All mobile refreshment businesses in the Town of Kingsville are required to complete this registration form which will be submitted to the Clerk's Department for review.

Please note that applicants must provide the following:

Commercial Liability Insurance
Current Mobile Preparation Premises Inspection Report from the Windsor-Essex Health Unit
Written permission from property owner (if applicable)
Fee payment of $250

All Businesses not registered may be liable for fines set out in By-law 90-2004.

Applicant Name

Address

City

Telephone number

Email address

Name of Business

Business Address

City

Business Telephone number

Business Email address

Is this a continuation of an existing business?

Yes

Proposed Date of Business Opening

Type of Business

Mobile Food Service Owner/Operator

Refreshment Cycle Owner

Number of Parking Spaces available

Type of Parking Spaces available

Public

Private

Commercial Liability Insurance $1,000,000

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Windsor-Essex Health Unit - Mobile Preparation Premises Inspection Report (please call 519-258-2146 for inspection)

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Written permission from property owner if parking in specific location

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Declaration

I hereby acknowledge that the License is subject to the provisions of the Town of Kingsville Licensing By-law 90-2004 and agree to comply with these provisions. The information contained in this application for a Business License is true and correct.

I am the applicant or, where the applicant is a corporation or partnership, I am a person whom has authority to bind the applicant.

Date

Name and Title

Mobile Refreshment License Application

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