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2 <br /> <br /> <br /> <br /> <br />For all municipal business license questions, contact: City of South Bend • Department of Community Investment <br />215 S. Dr. Martin Luther King Jr. Blvd. • Suite 500 <br />South Bend, Indiana 46601 • 574.235.5912 • F: 574.235.9021 <br /> <br /> <br />For Office Use Only <br />Application Filed License Fee Paid <br />Application Fee Paid License Number <br />Sent to Dept. <br />Health Department Approval Sticker Number Issued by H.D. <br /> <br />Not Approved <br />Reason <br />LICENSE APPLICATION FOR – FOOD VENDING MACHINE <br />SOUTH BEND MUNICIPAL CODE SECTION - 10-04 <br /> <br /> <br />I. APPLICATION TYPE Check One: New Renewal <br /> <br />II. BUSINESS DATA <br />A. Business Name <br />B. Location of Vending Machine(s) (include a separate sheet if necessary) <br /> <br />C. Business Mailing Address <br />City State Zip <br />D. Business Telephone Number <br />E. Business Fax Number <br />F. E-Mail Address <br />G. Location of commissary where foods are prepared for machines <br /> <br />H. Location where supplies are stored <br />I. Location where machine(s) are repaired or renovated <br />J. Types of products to be sold <br />K. Number of vending machines in operation by applicant at specified location(s) <br />III. PERSONAL DATA <br />A. Applicant's Legal Name: <br />B. Residential Address: <br />City: State: Zip: <br />C. Residential Telephone Number: <br />D. Cellphone Number: <br /> <br />