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2. Business Information
4. Trade Name (DBA):*
6. Mailing Address:*
8. City:*
9. State:*
10. Zip:*
12. Phone Number: *
13. Email Address: *
15. State Sales Tax I.D.:*
17. Please attach a copy of your Certificate of Good Standing- can be obtained at the Secretary of State website.*
18. Colorado Retail Food Establishment Mobile License issued by the State of Colorado.*
20. Proof of Fingerprinting:
21. Copy of Fort Lupton Fire District Approval (303-857-4603)*
23. Location of Business:
25. City:
26. State:
27. Zip:
29. If the mobile food vehicle will be parking on private property, please upload written consent of the property owner to operate on private property.
31. Business Owner Information:
33. Owner Name: *
35. Owner Address:*
37. City:*
38. State: *
39. Zip:*
41. Phone Number:*
42. Email Address:*
44. License Information:
46. Please give a brief explanation of the business:
48. Typical Hours of Operation:
50. Will alcohol be sold at the location?
    -- Select One --YesNo
51. Length in feet of the Vehicle:
53. Number of Employees Full Time:
54. Number of Employees Part Time:
56. Note that the city's lighting code limits illumination of exterior lighting to one hour before opening and to one hour after business closing.
58. I declare under penalty of perjury that all statements contained herein are to the best of my knowledge and belief, true and that all necessary land use permits, building permits, and any other permits required by law have been or will be secured prior to the commencement of the business activity which is the subject of this application.
59. Authorization:

    1. Yes
    2. No
Leave This Blank:


61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

63. Submit

* indicates a required field