Application for renewal of static vending approval

Permit number
Name of applicant/s
Applicant/s postal address
Name of business
Business phone (no spaces)
After hours phone (no spaces)
Business fax (no spaces)
Mobile phone (no spaces)
Email address

Street address of all current static vending machines

Site address 1
Site address 2
Site address 3

Vehicle / stall details

Type /description (eg vehicle / stall)
Registration number
Make
Model
Colour

Additional details

Operating days
Operating hours
Storage address of vehicle / stall
Premise/s where food products are prepared
Products offered for sale

Applicant's agreement and signature*

Name of Individual/Organisation
Name of Signatory If applicant is Corporation/Association
Position Proprietor, Director, Manager
Signature	I acknowledge Queensland State Laws will accept this communication as containing my signature with the meaning of the electronic Transactions (Qld) Act 2001
Date Signed

*If you are supplying commercially sensitive or confidential information, please ensure you mark such information clearly.

If the application is made by a corporation or an incorporated association, the person signing this form must occupy a position that is legally entitled to make an application on behalf of the organisation.

I understand that the information provided in and with this application may be disclosed publicly under the Right to Information Act 2009 and the Evidence Act 1977.

I am aware that it is an offence to knowingly provide false or misleading information.