Mobile Vendor Form

City of Mountain Home Letterhead

Mountain Home Building Inspection
720 South Hickory
Mountain Home, Arkansas 72653
Phone: 870-425-2550
Fax: 870-425-0477
mountainhomear.gov/building-inspection

Fields marked with * must be completed or form will not submit.

[{"type":"text","required":true,"label":"Name","placeholder":"First and Last Name","name":"name","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"Business Name","name":"Business-Name","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"Mailing Address","placeholder":"Street Address, City, State, Zip Code","name":"Mailing-Address","className":"col-md-6","subtype":"text"},{"type":"text","required":true,"label":"Business Address","placeholder":"Street Address, City, State, Zip Code","name":"Business-Address","className":"col-md-6","subtype":"text"},{"type":"text","subtype":"tel","required":true,"label":"Business Phone","name":"Business-Phone","className":"col-md-6"},{"type":"text","subtype":"tel","required":true,"label":"Cell Phone","name":"Cell-Phone","className":"col-md-6"},{"type":"text","subtype":"email","required":true,"label":"Email","name":"email","className":"col-md-6"},{"type":"text","subtype":"email","required":true,"label":"Email Confirmation","name":"email-confirmed","className":"col-md-6"},{"type":"text","required":true,"label":"Vendor Location","name":"Vendor-Location","className":"col-lg-4","subtype":"text"},{"type":"text","required":true,"label":"Federal Tax I.D. Number","name":"Federal-Tax-ID-Number","className":"col-lg-4","subtype":"text"},{"type":"text","required":true,"label":"Valid D.L. Number","name":"Valid-DL-Number","className":"col-lg-4","subtype":"text"},{"type":"header","subtype":"h3","label":"Owner of Building/Premises on which business is located:","className":"d-block"},{"type":"text","required":true,"label":"Owner of Premises Name","placeholder":"Owner of Premises First and Last Name","name":"Owner-of-Premises-Name","className":"col-md-6","subtype":"text"},{"type":"text","subtype":"tel","required":true,"label":"Owner of Premises Phone","name":"Owner-of-Premises-Phone","className":"col-md-6"},{"type":"text","required":true,"label":"Address of the Premises ","placeholder":"Street Address, City, State, Zip Code","name":"Address-of-the-Premises","className":"d-block","subtype":"text"},{"type":"header","subtype":"h3","label":"Persons to contact after business hours in case of emergency (Not business contact person)","className":"d-block"},{"type":"text","required":true,"label":"Emergency Contact's Name","placeholder":"Emergency Contact's First and Last Name","name":"Emergency-Contacts-Name","className":"col-md-6","subtype":"text"},{"type":"text","subtype":"tel","required":true,"label":"Emergency Contact's Phone","name":"Emergency-Contacts-Phone","className":"col-md-6"},{"type":"radio-group","required":true,"label":"Are you a Mobile Vendor or a Food Vendor?","name":"Are-you-a-Mobile-Vendor-or-a-Food-Vendor","className":"d-block","values":[{"label":"Mobile Vendor","value":"mobile-vendor"},{"label":"Food Vendor","value":"food-vendor"}]},{"type":"file","required":true,"label":"Please attach written permission from the property owner where you will be conducting business.","name":"Please-attach-written-permission-from-the-property-owner-where-you-will-be-conducting-business","subtype":"file","multiple":true,"className":"d-block"},{"type":"paragraph","subtype":"p","label":"(You may upload up to 20 files (35 Mb max). Files can be PDF, JPG, JPEG format). ","className":"d-block"},{"type":"header","subtype":"h3","label":"All mobile food vendors shall have the following contents on the premises at all times for inspection:","className":"d-block"},{"type":"paragraph","subtype":"p","label":"1.  A current health inspection ; food only","className":"d-block"},{"type":"paragraph","subtype":"p","label":"2. A valid driver's license; and","className":"d-block"},{"type":"paragraph","subtype":"p","label":"3. Vendors shall present a copy of the property owner's written authorization to operate on the designated property. The written authorization shall describe the approved location, and operation schedule.","className":"d-block"},{"type":"paragraph","subtype":"p","label":"4. A valid mobile vendor business license issued from the City of Mountain Home, Arkansas.","className":"d-block"},{"type":"checkbox-group","required":true,"label":"I hereby certify that I will abide by Ordinance 2020-48.","name":"I-hereby-certify-that-I-will-abide-by-Ordinance-2020-48","className":"d-block","values":[{"label":"I certify.","value":"i-certify."}]},{"type":"text","required":true,"label":"Applicant Signature","placeholder":"By typing your name, you are signing this form.","name":"Applicant-Signature","className":"col-md-6","subtype":"text"},{"type":"date","required":true,"label":"Today's Date","name":"Todays-Date","className":"col-md-6"},{"type":"header","subtype":"h4","label":"Fee: $150.00","className":"d-block"}]