Food Event Licence Application
Payment Information
Fee $ 100.00 per event
Payment:
Cash
Debit
Cheque
Visa/MC
Card # ________________________________________
Expiry Date: ________________
Business Information
Business Name:
Business Location: (Incl. Unit #)
City:
Postal Code:
Phone: (
)
Fax: (
)
Name of Event:
Date of Event:
Applicant Information
Full Name:
Sole Proprietor
*Partnership
Full Names of all Partners:
*Corporation
Full Name of Corporation:
Name(s) of authorized signing officers:
Applicant Address: (Incl. Unit #)
City:
Postal Code:
Phone: (
)
Fax: (
)
E-mail:
Documentation Required:
Articles of Incorporation and/or Business Name Registration
Certificate of Insurance with the Town of Halton Hills listed as the Certificate Holder ($2,000,000 general liablilty)
Signature of Applicant:
The information contained in this application is true and complete to the best of my/ our knowledge, and that failure to
provide complete or accurate information may delay the licensing process;
I/We acknowledge that the Licence is subject to the provisions of the Town of Halton Hills Business Licensing By-law
2005-0067 and agrees to comply with these provisions;
I am the applicant or in the case of a corporation or partnership, I am the person who has the authority to bind the
applicant’
It is an offence under to provide false or misleading information on this application or at any time hereafter to any
person having authority for the enforcement or administration of the by-law and that the provision of false or misleading
information may result in the prosecution and/ or penalties as set out in the by-law, or the refusal, suspension or
revocation of the business licence;
Applicant Name(s) (Print)
Signature(s)
Date