Food Safety Certification
Reimbursement Application

(IDDBA Retail Members Only)

To apply, select one of the following:

1. Apply online.
    
2. View or print the application (3 pages) from PDF format.
   You will need Adobe® Reader 6.0 or higher to view or print this document.
   

Mail or fax completed application and attachments to:

• Karen Peckham
• IDDBA
• P.O. Box 5528
• Madison, WI 53705-0528
• phone 608.310.5000 fax 608.238.6330

Don't forget to mail or fax these REQUIRED elements:

• Copy of invoice for payment of exam for each employee.
• Copy of certification certificate awarded to each employee or pass list on testing company letterhead.
• Name, store address, and home address for each certified employee. You must include the specific store name and title for each employee.