2. CONTRACTOR REGISTRATION FORM
4. Today's Date*
7. All registrations paid for in the current year will expire on December 31 of that year unless fees are paid in December in which case the registration will expire on December 31st of the following year. Fees are not pro-rated.
   Applications must include a copy of the contractor's driver's license and a copy of required state-issued license.
9. Contractor Type (Select one only)*
   -- Select One --Electrical (No Fee)General ($125.00 Fee)Irrigation ($125.00 Fee)Mechanical (No Fee)Plumbing (No Fee)Other
11. COMPANY INFORMATION
13. Company Name*
15. Company Mailing Address*
17. City*
18. State*
19. Zip*
21. Company Phone Number*
22. Email Address
24. Principal Owner's Name*
25. Principal Owner's driver license number*
27. Principal Owner's Mailing Address*
29. CONTRACTOR INFORMATION
31. Contractor Name*
33. Contractor Phone Number*
34. Contractor Email
36. Upload Driver License*
38. Upload CURRENT Trade License
40. MECHANICAL-TDLR Air Conditioning & Refrigeration License
42. ELECTRICAL-TDLR Electrical License
44. PLUMBING-TSBPE Master Plumbing License
46. IRRIGATION-TECQ Irrigators License
48. LICENSE HOLDER ELECTRONIC SIGNATURE & UNDERSTANDING OF RESPONSIBILITY*

    By checking “I agree” I understand and certify that it is my responsibility to adhere to all of the ordinances of the Town of Bartonville. I also agree and acknowledge my electronic signature is valid and binding in the same force and effect as a handwritten signature.

    1. I Agree
50. LICENSE HOLDER ELECTRONIC SIGNATURE*
52. After submission and your application is processed you'll be sent an email with a link to pay your application fee (if applicable).
Leave This Blank:


56. 1. Receive an email copy of this form.
57. Email address

    This field is not part of the form submission.

58. Submit Submit and Print

* indicates a required field