Application to Environmental Health for a Mobile trading permit

Applicant name *(required) (full name of applicant)

Company Name ( Company applicant must be a registered company)

Company registration number (if applicable)

Trading name

Applicant's postal address

Applicant's email address *(required) (please type in a valid email address - name@domain, name.name@domain (eg name@name.co.nz, name.name@name.org etc)

Applicant's contact phone number

Type of trading *(required) (please select an option)

Stall
Vehicle (trailer/caravan/truck)

Goods to be sold *(required) (please select all that apply)

Food
Other

If other (please specify the type of goods being sold)

Name of day-to-day operator: (if different to applicant)

Operator's postal address

Operator's contact phone number

Operator's email address (please type in a valid email address - name@domain, name.name@domain (eg name@name.co.nz, name.name@name.org etc)

Convictions Have you (the applicant/operator) been convicted of an offence relating to or in connection with the trade conducted pursuant to this licence application.

If yes, particulars to be stated:

Fees are reviewed annually in the Annual Plan - Environmental health fees and charges

Payment options are cash, credit card (Please note: a surcharge will be applied for all credit card payments at a service centre), eftpos or internet banking.

If you require an invoice:

Purchase order number (if required)

Send invoice via

Post
Email

Application to Environmental Health for a Mobile trading permit

Licensee Details

Mobile Shop Details

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