Borough of Butler Food License Application

* Fields in red are required

Borough of Butler Food License Application

Establishment Trade Name:

Establishment Address:

Establishment Phone #:

Establishment Fax #:

Email Address:

Owner / Operator:

Owner / Operator Address:

Owner / Operator Phone #:

Name of Certified Food Handler:

Name of Certified Food Manager (if applicable):

Name of Exterminator:

Phone number of Exterminator:

Payer Information

Billing Name:

Address:

Address 2:

City:

State:

ZIP Code:

Daytime Phone:

Payer E-mail Address:

Payment Information

Payment Amount:

Payment Method:

Convenience Fee:

Enter information as it appears on your check (USA Banks Only)

Routing Number:

Account Number:

Re-Enter Account #:

Using the following lower portion of a personal check as an example, enter the information that appears at the bottom of your check. Do NOT include any dashes or spaces.

Comments:

Terms & Conditions:

I affirm that I have completed the statements listed within this form and the information given is full and true and known to be so.

Each license issued under this Article must be prominently displayed on the premises where food sales are being conducted.

This License expires on December 31st. of year year in which it is issued and is not transferable. This license may be revoked by action of the Butler Borough Board of Health for failure to comply with applicable State and Local standards.

I agree to the above Terms and Conditions.

Community Instant Alerts Dial-A-Ride

If you have any trouble with accessing information contained within this website,
please contact:
Techsupport@butlerborough.com

Administration

Borough Clerk

Building Department

Butler Museum

Butler Schools

Butler Seniors

CORONAVIRUS - COVID19 INFORMATION

Electric Department

Emergency Management

Finance Department

Fire Department

Fire Prevention

Garbage, Recycling & Clean Communities

Health Department

LandUse/PlanningBoard

Library

Municipal Court

Ordinances

Police Department

Quotation Requests

Recreation Department

Stormwater Management

Surplus Property for Sale

Tax Office

Town Council

Water and Sewer Department

Zoning Department

Borough of Butler Food License Application

Borough of Butler Food License Application

Payer Information

Payment Information

Terms & Conditions: