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2. Name of Food Retail Establishment:*
   If you are a permitted food establishment in another Town/City, you MUST submit a copy of your permit. You can email it to healthdept@winchester.us or mail to Health Dept. 71 Mt. Vernon St, Winchester, MA 01890
4. Street Address*
6. Town/City*
7. State*
8. Zip Code*
10. Name of Owner*
11. Cell Phone
13. Establishement Phone #*
14. Email Address*
16. Name of Farmer's Market Event*
17. Dates Participating at Farmer's Market*
19. Location of Farmer's Market*
21. Name of Representative from YOUR establishment in charge of YOUR operation at Farmer's Market*
22. Cell Phone # of Representative*
24. How will you keep cold foods cold (41 degrees fahrenheit or less)?*
26. How will food be transported and appropriate food temperatures maintained?*
28. Is the food:
30. Pre-packaged/wrapped
    -- Select One --YesNo
31. Pre-weighed
    -- Select One --YesNo
32. Labelled (including ingredients)
    -- Select One --YesNo
34. List all food and beverage items that will be offered:*
36. Payment must be made before a permit will be issued. To pay online click below, or a $50 check payable to "Town of Winchester" can be mailed to: Winchester Health Dept., 71 Mt. Vernon St, Winchester, MA 01890
38. Online Payment
    Farmer's Market - TCS Vendor

    Once online payment is complete, you need to return to this page and “submit” application.
40. Signature of Applicant*
    By typing in your name, it will be considered an electronic signature
41. Date:*
Leave This Blank:


42. 1. Receive an email copy of this form.
43. Email address

    This field is not part of the form submission.

44. Submit

* indicates a required field