2. First Name
3. Last Name
5. Address1
7. Address2
9. City
10. State
11. Zip
13. Phone Number*
15. Email Address*
17. Name of Firm*
19. Business Owner's Name*
21. Type of Business*
23. Please attach copies of driver's license, state license and proof of insurance
25. Upload Files copy of DL*
27. Upload Files Insurance*
29. Upload Files State License
31. License Information & fee
    No license shall become effective until the required certificate of insurance has been submitted and is on file with the city. Roofing Contractors have a $75.00 registration fee.
33. Electronic Signature
    By checking I agree and acknowledge my electronic signature is valid and binding in the same force and effect as a handwritten signature.
35. Check here*

    1. I agree
37. Type Name Here*
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39. 1. Receive an email copy of this form.
40. Email address

    This field is not part of the form submission.

41. Submit

* indicates a required field