Retail Food Sanitation License
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Company Information
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Company Info
2
Store Info
3
Review
4
Payment
4
Confirmation
Type of Ownership
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Select a Ownership Type
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Partnership
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Company Name
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Store Owner/Partner/Manager
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Type of Establishment
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Full Service Grocery Store
Convenience Store
Other
Registered Legal Agent Representing Business (as filed with the Secretary of State)
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Registered Agent Address 1
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Registered Agent Address 2:
Registered Agent City
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Registered Agent State
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Registered Agent Zip Code
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Registered Agent Phone Number
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Employer ID Number/ Federal Tax ID Number (IF SSN, LEAVE BLANK)
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Email Address
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