Business Connect | Applying For Food Safety Permits

Business Connect Events
Name*

First NameLast Name
Email (double check spelling)*
example@example.com
Phone Number*
Please enter a valid phone number.
Would you like to receive a text reminder for the event?

Yes, please remind meNo, thank you. I'll remember
Home Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Race/Ethnicity (Select all that apply)*

AfricanAsianBlack or African AmericanHispanic or Latino/Latina/LatineMiddle Eastern/North AfricanNative American or Alaskan NativeNative Hawaiian or other Pacific IslanderWhiteOther
Business Information
How long have you been in business?*

Idea PhaseLess than a year1-2 years2-5 years6-10 years10+ years
Is your business address the same as your home address?*

YesNo
What industry is your business in?
Name of Business*
If you are not registered yet, enter N/A
Business Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Household Information

This data allows us to continue to receive the necessary funding to offer services at no cost to our clients.
Household Size*
Number of people in your household
ANNUAL Gross Household Income (do not use $ sign or commas)*
Do you have children under 18 years old attending local schools?*

YesNo
What schools do your children attend?
This allows us to work with Family Community Resource Centers (FCRC) to provide support to families
*All information collected is kept strictly confidential and will only be used for the purpose of communication regarding the service, program, or opportunity being offered, and will not be used for any other purposes.
By attending this event, you agree to be photographed and/or filmed and give permission to use your likeness in promotional and/or marketing materials.
Should be Empty:

Business Connect Events

Business Information

Household Information

*All information collected is kept strictly confidential and will only be used for the purpose of communication regarding the service, program, or opportunity being offered, and will not be used for any other purposes.

By attending this event, you agree to be photographed and/or filmed and give permission to use your likeness in promotional and/or marketing materials.