Mobile Food Vendor License Application

Note: A mobile food vendor application will not be processed until the Village has also received a completed Places for Eating Tax registration.

Name of Owner:

*required

Phone Number:

( ) -

*required

Email:

*required

Mailing Address:

*required

Name of Business/Truck:

*required

State of Illinois Sales Tax ID (4 digit):

*required

Name(s) of Operator(s):

*required

Vehicle License Plate Number:

*required

Intended Location(s) of Operation:

*required* If no defined locations, put Variable.

Requested Day of Operation:

*required

Proof of Insurance as required by Ordinance 20-18:

Does this vendor solely serve ice cream treats as described in Ordinance 20-18?:

*required

Is this application for a special event (e.g., Coon Creek Days)?:

*required

If so, what event?:

*required

I hereby certify all the information provided here is accurate. I have read and understood Ordinance 20-18, “Regulation of Mobile Food Vendors.” I understand that this application is not itself approval to operate in the Village of Hampshire and that I must obtain a license as described in the Mobile Food Vendor License Packet, including paying a $250 permit fee at the time of pick-up ($50 for ice cream trucks). I also understand that obtaining a Mobile Food Vendor License does not exempt truck operators from obeying all traffic laws and all other ordinances and laws, including submitting a Places for Eating Tax Return.:

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