Form Center

2. Township Clerk
   641 Plainsboro Road
   Plainsboro, NJ 08536
   Phone: 609-799-0909, ext. 2547
3. Date
   Date
5. Name of Establishment
7. I, or We, the undersigned, do hereby make an application for a license to conduct an eating, drinking or retail food establishment in the Township of Plainsboro located at:
9. Address
11. City
12. State
13. Zip Code
15. Contact Name
16. Phone Number
18. Email Address
20. In making this application, I or We, agree to comply with all the Ordinances of the Township of Plainsboro and the Laws of the State of New Jersey covering such establishments. It is further agreed that I, or We, will surrender this license, if granted, to the Department of Health on demand.
22. Electronic Signature Agreement

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.

    1. I agree.
24. Electronic Signature
26. Address
28. City
29. State
30. Zip Code
32. Email
34. Contact Person
35. Contact Phone
37. ***Penalties are assessed if the annual fee is not paid by the January 31st due date per Township Ordinance Chapter 69***

    To avoid being overcharged, please select only ONE option from the category that applies to your business type (either “Restaurant Type Establishments” or “Food Stores, Delicatessens, Bakeries, and All Other Food Handling Establishments”). Selecting options from both categories will result in an incorrect payment.

39. RESTAURANT-TYPE ESTABLISHMENTS:
    (select one option ONLY IF your business falls under this category)
41. PRICE

    1. 1 - 50 seats - $150.00

    1. 51-200 seats - $250.00

    1. 201 seats and over - $350.00
43. Quantity
44. Shipping Cost
45. Taxable
47. FOOD STORES, DELICATESSENS, BAKERIES, AND ALL OTHER ESTABLISHMENTS HANDLING FOOD:
    (select one option ONLY IF your business falls under this category)
49. PRICE

    1. 0-3,500 sq. ft. - $150.00
    2. 3,501 - 5000 sq. ft. - $250.00

    1. 5,001 - 10,000 sq. ft. - $350.00
    2. Over 10,000 sq. ft. - $450.00
51. Quantity
52. Shipping Cost
53. Taxable
55. For Office Use Only:
Leave This Blank:


59. Calculate Totals Proceed to Checkout

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