Company Name*

Company Address*

City*

State*

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Zip Code*

Contact Person

Phone Number*

Fax Number

E-mail Address

Name of Owner*

Type of Contractor

Electrical - $90 HVAC (Mechanical) - $75 Irrigation - $75 Plumbing - N/C General - N/C Sign (no electrical) - N/C Sign (w/electrical) - $90

Name of License Holder

Please attach a copy of driver's license, state contractor license, certificate
of insurance, and calibration report(if applicable)
**General contractors need only provide owner's driver's license***

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Electronic Signature -- Please type the name of the person submitting this application.*

I authorize the City of Rowlett to charge my credit card as follows:

Single Payment of Contractor Registration fee

Credit Card Number

Credit Card Type

VISA MasterCard

Expiration Date (mm/yy)

Printed name on card

Billing Address for this Credit Card

This address must be where the bill is delivered to or the card will be declined by by your bank.

Zip Code

Electronic Signature -- Please type the name of the person authorizing this charge.