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Get APPLICATION FOR FOOD ESTABLISHMENT Complete ... - Hcphes

AL PUBLIC HEALTH DIVISION APPLICATION FOR FOOD ESTABLISHMENT Date: Est. No.: ESTABLISHMENT AND OWNER INFORMATION Proposed Business Name: Proposed Business Site Address: Name to Enter on Permit (e.g., LLC, Inc.): City: Zip Code: Name of Owner or Registered Agent (Individual): Mailing Address: City: State: Phone No.: Zip Code: Driver s License No.: State: Expiration: Email Address: Contact Information (if different from the permit holder): Name: Business Name: Phone No.: Alterna.

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