Cottage Food Producer Permit Application
Applicant Information
Full Name
Date of Birth
Phone Number
Email Address
Home Kitchen Address
Street Address
City
State
Zip Code
Business Information
Business Name (if any)
List of Cottage Foods to be Produced
How will products be distributed?
Certifications
Have you completed a food handler training course?
Yes
No
If yes, provide course name, provider, and date of completion
Signature
Applicant Signature
Date