Contractors Registration/Renewal

2. Check what applies*

   1. New Contractor Registration
   2. Contractor License/COI & Workers Comp Update
   3. Private Provider Registration
4. Permit # or GoPost ID for permits ON HOLD only! *

   Please type in a Permit # or GoPost ID # that is ON HOLD up to expedite the process. 

   NEW REGISTRATION please type NA 

   Otherwise processing time is 1-3 business days. 

6. Name of Company *
8. Company/Contractor/Private Provider Address*
10. Contractor State License Number*
12. Contact Phone Number*
14. Contractor/Company Email *

    Please use a valid email. All  approvals will be sent to email provided.

16. License Holder Name*
18. PCCLB If applicable*

    If Not Applicable put NA

20. Upload Documents

     Upload documents below that apply to your situation. 

22. Upload Certificate of Insurance

    C.O.I

23. Upload Worker's Comp or Exempt Here

    Worker's Comp or Exempt 

25. Upload Contractors License Here

    Contractors License 

27. Private Provider Paperwork
29. Private Provider Paperwork
31. Other

    Upload any documents you think we may need. 

33. Comments

    Please leave all comments for intake specialist here. 

Leave This Blank:


35. 1. Receive an email copy of this form.
36. Email address

    This field is not part of the form submission.

37. Submit

* indicates a required field