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Contractor Registration
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W10=
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Date
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Company name
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Street address
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City
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State
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Zip Code
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Phone
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Email
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Licensee name
*
State license number
*
Registration type
Please select one
Building residential = $20
Mechanical = $15
Electrical = $20
Plumbing = $1
Building commercial: $20
Fence: $20
Sign: $20
Right of way: $20
Shed: $20
Fire suppression: $20
Fire alarm: $15
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Electronic signature
By typing my name here and submitting this form, I certify that the information provided is true and correct to the best of my knowledge. I understand that my typed name constitutes my electronic signature and has the same force and effect as a handwritten signature.
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Type your full name to confirm:
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Upload supporting documents
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Attach copy of driver's license and contractor license
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