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2. 
3. Division of Building Regulation
   Contractor Information Form
7. Name of Individual:*
9. Name of Company:*
10. Type of Company

    1. Sole Proprietorship
    2. Partnership
    3. Corporation
12. Name of President/Owner/Partners:*
14. Mailing Address:*
16. City:*
17. State:*
18. Zip Code:*
20. Telephone Number:*
21. Fax Number:
22. Mobile Number:
26. State Contractors License Number:*
27. Expiration Date:*
    Expiration Date:
28. Class*
    -- Select One --ABC
30. List Types:
32. Designated Tradesman:
33. Tradesman License Number:
34. Expiration Date:
    Expiration Date:
36. Other Business License Number:
37. Locality:
38. Expiration Date:
    Expiration Date:
40. York County Business License Number:
41. Expiration Date:
    Expiration Date:
43. Name of Contact Person:
44. Phone Number of Contact Person:
45. Email Address:
47. List of Persons associated with your Company that will be authorized to sign and obtain permits for your Company:
49. Electronic Signature of Applicant:*
50. Today's Date:*
    Today's Date:
54. COPIES OF LICENSES REQUIRED FOR VERIFICATION
56. Upload Licenses or Submit in Office:
    .pdf Format Only
57. Upload Licenses or Submit in Office:
    .pdf Format Only
59. Upload Licenses or Submit in Office:
    .pdf Format Only
60. Upload Licenses or Submit in Office:
    .pdf Format Only
Leave This Blank:


62. 1. Receive an email copy of this form.
63. Email address

    This field is not part of the form submission.

64. Submit

* indicates a required field