2. 
3. Annual Food Permit Payment Form

   Please complete this form after you have submitted your application through DocuSign.

5. First Name*
6. Last Name*
8. Phone Number*
10. Email Address*
12. Business Name(s)*
14. Permit Number(s)*
16. Business Address(es)*
    You must list all the business addresses for all the permits you are paying for at this time. For example, if you have 3 locations, you can fill out 3 applications through DocuSign, and then use this one payment form to pay for all three applications. Just list all three business location addresses.
18. Annual Food Permits are due January 31, 2022. Any application received after this date is subject to a 75% late fee. The prices below reflect this late fee.
20. Gross Sales between $0.00 and $49,999.99
    $75 Annual Permit
21. Price
22. Quantity
23. Shipping Cost
25. Taxable
27. Gross Sales between $50,000.00 and $149,999.99
    $100 Annual Permit
28. Price
29. Quantity
30. Shipping Cost
32. Taxable
34. Gross Sales between $150,000.00 and $249,999.99
    $125 Annual Permit
35. Price
36. Quantity
37. Shipping Cost
39. Taxable
41. Gross Sales between $250,000.00 and $499,999.99
    $150 Annual Permit
42. Price
43. Quantity
44. Shipping Cost
46. Taxable
48. Gross Sales between $500,000.00 and $749.999.99
    $200 Annual Permit
49. Price
50. Quantity
51. Shipping Cost
53. Taxable
55. Gross Sales between $750,000.00 and $999,999.99
    $250 Annual Permit
56. Price
57. Quantity
58. Shipping Cost
60. Taxable
62. Gross Sales between $1,000,000.00 and $1,249,999.99
    $300 Annual Permit
63. Price
64. Quantity
65. Shipping Cost
67. Taxable
69. Gross Sales between $1,250,000.00 and $1,499,999.00
    $325 Annual Permit
70. Price
71. Quantity
72. Shipping Cost
74. Taxable
76. Gross Sales over $1,500,000.00
    $375 Annual Permit
77. Price
78. Quantity
79. Shipping Cost
81. Taxable
83. Initial Administrative Fee
    if applicable
84. Price
85. Quantity
86. Shipping Cost
88. Taxable
90. Online Payment Fees:
    Online payments are processed by Forte. A fee of 2.5% or $1.50 (whichever is greater) will be assessed for all credit card payments. Electronic Checks are also accepted, and will be assessed a flat $1.25 for any payment under $50,000. The appropriate fee will be added to the total cost of your payment.
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91. Calculate Totals Proceed to Checkout

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