Tooele Health Department
             
Tooele County Health Department
151 N. Main Street, Suite 140 - Tooele, UT 84074
Phone (435) 277-2440 Fax (435)277-2444

Tobacco Handler Application
Tobacco Handler Permit will be issued once test results from Tobacco Handler Quiz are reviewed.


Please put N/A for any fields that are not applicable
Applicant's Information
First Name: Last Name:
Address:
Address:
City: State/Province: ZIP/Postal Code:
Phone:
Email:
Date of Birth
Place of Employment
Age

**Read and Sign**

I agree to abide by all local ordinances and laws of the State of Utah governing the sale of TOBACCO. I understand that failure to do so may result in revocation of my tobacco handler permit and/or other action as the law requires. 

Signature of Applicant
Date

Tobacco Handler Permit:   $10.00   Item Subtotal:  
$10.00
Total:
$10.00
Payment Information:
Method of Payment:
 Update Name from Personal/Organizational Information
Name on Account:
Routing Number:
Account Number:
Institution:
Name on Card:
Account Number:
Expiration Date:
Billing Street Address:
Billing ZIP/Postal Code:
 Change Payment Method
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