2. Name of company*
3. Company address*
4. Company phone *
6. Contact person*
7. Contact's phone*
8. Contact's fax
10. Contact's email
12. Type of contractor*
    -- Select One --GeneralElectricalHVACPlumbingOther
13. Type of registration*
    -- Select One --Initial registration $150Renewal registration $150

    Select renewal only if you were registered in the previous year.

14. Tax ID number*
16. Upload state license
17. Upload liability insurance*
    $300,00 for injury or death, $100,000 for property damage with the City of Barberton named as additional insured.
19. I hereby make application for registration as a State Licensed Contractor or a General Contractor with the City of Barberton.
21. Signature of Contractor*
    Please type full name.
Leave This Blank:


23. 1. Receive an email copy of this form.
24. Email address

    This field is not part of the form submission.

25. Submit

* indicates a required field