Contractor Registration

2. 
4. Contractor Registration Application
6. Company Name *

   Name of Company

7. DBA Name if required

   DBA Name if required

9. Name*

   Full name of someone with financial accountability for the company.

10. Title *

    Title held within the company

12. Company Address*
14. City*
15. State*
16. Zip Code*
18. Phone Number*
19. Federal Tax ID#*
21. Email Address*

    This will be the email address for all permits and communication

23. Commercial or Residential*
    -- Select One --CommercialResidentialBoth

    Please select if you generally work for commercial or residential or both

25. Trade Type*

    Please select the trade you will be doing work under

    1. Asphalt/Paving
    2. Concrete
    3. Excavation
    4. Electrical
    5. Excavation

    1. Fence
    2. Fire Protection
    3. General
    4. HVAC
    5. Kitchen/Bath Remodeling

    1. Masonry
    2. Plumbing
    3. Roofing
    4. Siding/Gutters
    5. Sign

    1. Steel Erectors
    2. Storage Sheds
    3. Tent Installer
    4. Waterproofing
    5. Window/Doors
27. Upload Certificate of Insurance*

    COI listing City of Brooklyn as certificate holder. 

28. Upload State Licenses

    HVAC, Electrical, Plumbing, Fire Protection

30. Electronic Signature Agreement*

    By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date. 4) I do hereby certify that I will abide by the provisions of the Brooklyn Codified Ordinances, which I am fully aware of the requirements of the Building Codes that all required permits will be obtained and this will be strictly observed subject to forfeiture of the Certificate of Registration. By signing below I also hereby acknowledge I will contact Ohio Protection Services (800-362-2764) and abide by the EPA Lead Safe Work practices if applicable. I do hereby certify that the facts contained in and attached to the foregoing application are true to the best of my knowledge and belief.

    1. I agree.
32. Electronic Signature*
33. Date*
    Date
35. Fee: $100

    The city will call to secure payment with a credit card (no additional fee) or you can mail in a check to : 7619 Memphis Ave, Brooklyn, Ohio 44144

36. Form of Payment*
    -- Select One --Check to be mailed inPlease call for credit card
Leave This Blank:


38. 1. Receive an email copy of this form.
39. Email address

    This field is not part of the form submission.

40. Submit Submit and Print

* indicates a required field