Online Contractor Registration Form

Town Registration Requirements:

Copy Current State-Issued License and Current Driver's License

Contractor Type *

Company Information

Company Name *

Company Type *

Company Contact Email Address *

Street Address *

City *

State *

Zip Code *

Phone Number *

Tax ID Number *

Owner Information

Owner Name *

Owner Email Address *

Street Address *

City/State/ZIP Code *

Phone Number *

Tax ID Number *

Is the owner/contractor also the licensee? *

Yes

Licensee Information

Licensee Name *

Licensee Email Address *

Licensee Address *

City/State/ZIP Code *

Phone Number *

License Number *

Copy of Current State-Issued License/Current Driver's License/Certificate of Insurance

PLEASE ATTACH A COPY OF YOUR CURRENT STATE-ISSUED LICENSE, DRIVER'S LICENSE, AND/OR CERTIFICATE OF INSURANCE
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png.

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Online Contractor Registration Form