Commissary Kitchen Membership Application

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Commissary Kitchen Membership Application

HAEC offers memberships to food service professionals such as food trucks, caterers, and other types of certified food handlers. Choose the membership that best suits your needs as a food business and become a part of a group of creative individuals who use the co-working space to amplify their food service. Fill out an application and take a tour of the facility to see how the HAEC can meet your needs.

Business Name*

Main Contact for Business*

First Name*

Last Name*

Email*

Phone*

Address*

Address Line 1

Address Line 2

City

State

ZIP Code

Membership Level*

Level A | 20hrs/month - $360/month Level B | 40hrs/month - $680/month Level C | 80hrs/month - $1280/month Hourly - $20/

Type of Food Service

Caterer Food Truck Meal Prep Service Specialty Food Products (online sales, farmers markets) Other

Do you have a food service certification from the Huntington County Health Department? If you are certified in another county please choose other.*

Yes No Other

What county are you certified?*

Desired Start date of Membership

https://pathfinderservices.formstack.com/forms/images/2/calendar.png

Month

Day

Year

Please select a date on the 1st or 15th of the month

Describe your food business and the anticipated capacity of the kitchen use*

Demographic Information

*All demographic information obtained will not be attached to your name. The data collected will not be used for marketing purposes in any way.

Age*

0-4 5-17 18-64 65+

Gender*

Male Female Non-Binary

Race/Ethnicity*

Native American or Alaska Native Black or African American Asian Native Hawaiian or Pacific Islander Hispanic or Latino White or Caucasian – not Hispanic or Latino Two or more races Other

Marital Status*

Never Married Married Divorced Widowed

Veteran*

Yes No

Household Income*

Less than $10,000 $10,000 to $24,999 $25,000 to $49,999 $50,000 to $74,999 $75,000 to $149,999 Over $150,000

Household Size*

1 2 3 4 5 6 7 8+

Zip Code*