Form Center

SJC Food Services

Food Services Payment Form
Please complete this form after you have submitted your application through DocuSign.
Name of Establishment*
Permit # / Event Name*
For new establishments, enter "New".
Continue

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.
Establishment 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.
Gross Sales between $0.00 and $49,999.99
$75 Annual Permit
Price
Quantity
Shipping Cost
Gross Sales between $50,000.00 and $149,999.99
$100 Annual Permit
Price
Quantity
Shipping Cost
Gross Sales between $150,000.00 and $249,999.99
$125 Annual Permit
Price
Quantity
Shipping Cost
Gross Sales between $250,000.00 and $499,999.99
$150 Annual Permit
Price
Quantity
Shipping Cost
Gross Sales between $500,000.00 and $749.999.99
$200 Annual Permit
Price
Quantity
Shipping Cost
Gross Sales between $750,000.00 and $999,999.99
$250 Annual Permit
Price
Quantity
Shipping Cost
Gross Sales between $1,000,000.00 and $1,249,999.99
$300 Annual Permit
Price
Quantity
Shipping Cost
Gross Sales between $1,250,000.00 and $1,499,999.00
$325 Annual Permit
Price
Quantity
Shipping Cost
Gross Sales over $1,500,000.00
$375 Annual Permit
Price
Quantity
Shipping Cost
Initial Administrative Fee
if applicable
Price
Quantity
Shipping Cost
Taxable
Taxable
Taxable
Taxable
Taxable
Taxable
Taxable
Taxable
Taxable
Taxable
Continue |Go Back

Due Date: 7 Days prior to event
An additional 100% cost of the permit if payment is made less than 7 days prior to the event.
Food Temporary Permit Application:
One Day Event Fee
On Time Price:
Quantity
Shipping Cost
Taxable
Food Temporary Permit Application:
One Day Event with Late Fee
Late Fee Price: $30.00 + $30.00
Quantity
Shipping Cost
Taxable
Food Temporary Permit Application:
Two to Three Day Event Fee
On Time Price:
Quantity
Shipping Cost
Taxable
Food Temporary Permit Application:
Two to Three Day Event with Late Fee
Late Fee Price: $50.00 + $50.00
Quantity
Shipping Cost
Taxable
Food Temporary Permit Application:
Four to Ten Day Event Fee
On Time Price:
Quantity
Shipping Cost
Taxable
Food Temporary Permit Application:
Four to Ten Day Event with Late Fee
Late Fee Price: $130.00 + $130.00
Quantity
Shipping Cost
Taxable
Food Temporary Permit Application:
Annual Permit Fee
Price:
Quantity
Shipping Cost
Taxable
Continue |Go Back

Name of Establishment: *
Permit # / Event Name:
First Name: *
Last Name:*
Phone Number: *
Email Address: *
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.

Leave This Blank: