BIRMINGHAM TOWNSHIP, CHESTER COUNTY 1040 WEST STREET RD WEST CHESTER, PA 19382 (610)793-2600 (610) 793-3417 FAX
GENERAL CONTRACTOR REGISTRATION APPLICATION NOTE: All required information must be completed or the application will be returned. Please Print or type all information.
SIGNATURE ___________________________________
1.
BUSINESS INFORMATION Name of Firm: ________________________________________________ Business Address: _____________________________________________ _________________________________________________________ Business Phone: ________________________________________________
2.
GENERAL CONTRACTOR INFORMATION Name: ________________________________________________________ Home Address: ________________________________________________ ________________________________________________ Home Phone: __________________________________________________ Cell Phone: ____________________________________________________
Have you taken a written contractor’s exam? If so, what type –please specify ________________________________________________________________ _________________________________________________________________ List all subcontractors: _________________________________________________________________ _________________________________________________________________ _________________________________________________________________ __________________________________________________________________
3.
REGISTRATION FEE ANNUAL FEE: $100
IMPORTANT NOTICE
Contractor must submit certificates of insurance to obtain registration certificate to work in the Township. Such certificate of insurance shall include WORKERS’ COMPENSATION. Should workers’ comp insurance expire for any reason, the contractor’s registration will be immediately revoked.