Restaurant or Caterer Application

Thank you for taking the time to apply for kosher certification with Kosher.

This is a complimentary service and only takes a few minutes to complete. The information provided will be kept strictly confidential and allow our coordinators to assess the requirements, timeline and cost for your kosher program.

If you are unable to complete this form online, please download a PDF here.

General Information

Name of Establishment*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Mobile*

Email*

Fax

Website*

Management/Ownership

Manager Name*

First Last

Is the manager Jewish?*

Yes
No

Does a different company own the restaurant/caterer?*

Yes
No

Name of Company*

Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Fax

Owner Name*

First Last

Is the owner Jewish?*

Yes
No

Facility Information

Type of Restaurant

The Facility will be serving:*

Only Pareve
Dairy
Meat
Both

Will there be any:*

Takeout
Outside Catering

Days of Operation:*

Sunday
Monday
Tuesday
Wednesday
Thursday
Friday until 2 Hours before sundown
Shabbos
Sat. Night

Hours of Operation*

Are you planning to be open during Passover?*

Yes
No

Is this a new establishment?*

Yes
No

Is all the equipment brand new?*

Yes
No

Is any of it refurbished?*

Yes
No

Have you been certified previously?*

Yes
No

By whom?*

A processing fee of $500.00 must be paid before the initial visit can be scheduled. If restaurant is not eligible for certification, Kosher will retain the $500.00 in consideration of its administrative and other costs in connection with the application process.

THIS APPLICATION DOES NOT INCLUDE PASSOVER. Passover certification can be requested separately, a minimum of 90 days prior to Passover is required.

Electronic Signature

I have read and agreed with the terms and conditions above and indicate my acceptance by checking this box and by typing and entering my name in the electronic signature box below. By checking this box and by typing and entering my name below, I authorize my electronic signature to carry the same weight and legal effect as my written signature.

Name

First Last

Additional comments/notes

UTM Capture

Companies

General Information

Management/Ownership

Facility Information

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