BOROUGH OF COLLEGEVILLE
GENERAL CONTRACTOR REGISTRATION APPLICATION
PLEASE NOTE: Registration is for Commercial General Contractors ONLY
NAME OF
COMPANY:_____________________________________________________________
ADDRESS:_____________________________________________________________
EMAIL: ________________________________________________________________
PHONE NO. _______________________ FAX: ______________________________
PA REGISTRATION NUMBER: ____________________________________________
INSURANCE CO: _______________________________________________________
INSURANCE AGENT: ___________________________________________________
I certify that the statements contained herein are true and correct to the best of my
knowledge and belief. I understand that if I knowingly make any false statements herein,
I am subject to penalties as may be prescribed by law or ordinance.
APPLICANT: ___________________________________________________________
Borough of Collegeville
491 E. Main Street
Collegeville, PA 19426
610-489-9208 610-489-6661 Fax www.collegeville-pa.gov
OFFICIAL USE ONLY
REG. NUMBER: ____________ STATE OF PA REG. NUMBER: ______________
AMOUNT PAID: ____________ CHECK NUMBER: _______________________
DATE PAID: _________________________________________________________
DATE REGISTRATION CARD ISSUED: ___________________________________
APPROVED BY: ______________________________________________________
DATE: ______________________________________________________________
