Iowa Division of Labor
Contractor Registration
150 Des Moines Street
Des Moines, IA 50309-1836
Phone: 515-242-5871
Fax: 515-725-2427
contractor.registration@iwd.iowa.gov
www.iowacontractor.gov
Removal/Additional Owner,
Officer, Partner or
Member Form
Add Remove
Owner, officer, partner or member name
Email address
Phone number
Address
City
State
Zip
Add Remove
Owner, officer, partner or member name
Email address
Phone number
Address
City
State
Zip
Add Remove
Owner, officer, partner or member name
Email address
Phone number
Address
City
State
Zip
Add Remove
Owner, officer, partner or member name
Email address
Phone number
Address
City
State
Zip
Add Remove
Owner, officer, partner or member name
Email address
Phone number
Address
City
State
Zip
I certify that the information on this form and the attachments is true and accurate to the best of my knowledge.
Name of individual completing form
Signature
Contractor registration #
Email address
Phone number
Date
Business Name:
click to sign
signature
click to edit