TEMPORARY FOOD SERVICE VENDOR PERMIT APPLICATION TEMPORARY FOOD SERVICE VENDOR PERMIT APPLICATION WITH LATE FEE Effective 09/01/2024 Temporary Food Permit Fees will increase to $50 per day for the first two days and $25 for each additional dayToday's Date(Required) MM slash DD slash YYYY Date(s) of event or activity:(Required) MM slash DD slash YYYY This field is hidden when viewing the formDays Until EventIf your event is less than 7 days from today a late fee will be charged.Time of Operation:From(Required) Hours : Minutes AM PM AM/PM To(Required) Hours : Minutes AM PM AM/PM Location of Event(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Name of Booth/Organization:(Required)Assigned Spot:SPPHD MUST BE NOTIFIED AT LEAST 7 DAYS PRIOR TO EVENT. PERMIT FEE MUST BE PAID AT LEAST 3 DAYS PRIOR TO EVENT. if not notified there will be an additional fee of $100 $50 for the first 2 days - $25 for each additional day. NO REFUNDS WILL BE ISSUED* *We may issue credit for a later event. NO FOOD MAY BE PREPARED FROM HOME. ALL FOOD MUST BE PREPARED ON SITE OR AT AN APPROVED FACILITY.RESPONSIBLE PERSON (MUST BE AVAILABLE THE DAY(S) OF EVENT IN CASE INSPECTOR HAS QUESTIONS)Name(Required) First Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone:(Required)Alternate Phone:Email:(Required) No person shall operate a Temporary Food Establishment without a valid permit issued by the South Plains Public Health District. Only an establishment which complies with the requirements of the Texas Food Establishment Rules, issued by the Texas Department of State Health Services and adopted by the South Plains Public Health District, shall be entitled to receive or retain such permit. Temporary Permit $50/per day for the first two days, $25 for each additional day.PAYMENT METHOD:(Required) Check Cash Credit Card Non-Profit or 501c(3) Status (attach paperwork) FIRST DAY FEE: One Day $50.00 Two Days $100.00 NUMBER OF ADDITIONAL DAYS:FIRST DAY FEE CC: One Day $50.00 Two Days $100.00 NUMBER OF ADDITIONAL DAYS CC: Quantity Price: $25.00 Quantity Processing Fee Price: $3.73 Late Fee Price: Coupon Total FileAccepted file types: jpg, png, pdf, Max. file size: 1,000 MB.Explain non-profit event statusCredit Card Cardholder Name Card Details FOOD ITEMS TO BE SERVED:(Required)PLACE OF PREP AND STORAGE: Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code NOTE: ONLY FOODS AND BEVERAGES LISTED ABOVE WILL BE ALLOWED ON DAY(S) OF EVENTCAPTCHA
