Follow the steps to fill out the form confidently.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In section I, complete the fields for the food facility owner. Enter the facility name, health permit number, mailing address, city, street number, zip code, permit owner's name, phone number, fax number, and email.
3. In section II, the commissary/headquarters owner must provide their approval. Fill in their facility name, health permit number, address, city, street number, zip code, permit owner's name, and email.
4. Review the checkboxes for the services that the food facility can utilize. Ensure that all relevant options such as food preparation, food storage, and vehicle/cart washing area are selected as needed.
5. The commissary/headquarters owner should sign, print their name, and include the date at the bottom of the form.
6. Once all fields are accurately filled, you may save your changes, download, print, or share the completed form.

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