City of Powell, Ohio | Contractor Registration Form

Registration Year*

Company Name*

Type of Business/Contractor:*

Mailing Address*

Street Address Address Line 2 City State ZIP Code

Phone*

Mobile Phone

Fax

Email*

Company Federal ID / SS Number*

Workers Compensation Certificate # (if required by State law)

Certificate Expiration Date

Contact Name*

Owner/CEO Name*

Signature*

Date Signed*

Certificate of Liability Insurance-City of Powell must be listed as a certificate holder*

Max. file size: 250 MB.

Workers Compensation Certificate

Max. file size: 250 MB.

Applicable Licenses

Drop files here or

Max. file size: 250 MB.

Copy of the State of Ohio License for registrants applying for Electrical, HVAC, Plumbing, Hydronics and Fire Protection Registration.

Fee*

Price:

Processing Fee*

Price:

Total

$0.00

Name*

First Last

Credit Card*

Card Details

Cardholder Name

Total

$0.00

Contractor Registration Form