Fillable Plumbers Registration And Checklist 2017 (Borough of Collegeville)

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Plumbers Registration And Checklist 2017 (Borough of Collegeville)

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8/17/17
BOROUGH OF COLLEGEVILLE
PLUMBING CONTRACTOR REGISTRATION APPLICATION
Name of Company: _________________________________________________
Address: __________________________________________________________
Email: ____________________________________________________________
Phone No.: _______________________ Fax No.: ________________________
PA State Registration No.: ____________________________________________
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: _______________ PA STATE REG. NUMBER: ____________
AMOUNT PAID: ____________________ CHECK NUMBER: _______________
DATE PAID: _______________________________________________________
DATE REGISTRATION CARD ISSUED: _________________________________
APPROVED BY: ____________________________________________________
DATE: ____________________________________________________________
8/17/17
BOROUGH OF COLLEGEVILLE
PLUMBING CONTRACTOR REGISTRATION CHECKLIST
Applicant should provide the following three items in order to obtain their
Plumber’s Registration:
PA State Registration Number
Copy of current registration card from another municipality (both sides)
Copy of Certificate of Insurance listing as the certificate holder:
Collegeville Borough
491 E. Main Street
Collegeville, PA 19426
Check for the correct amount
$100.00 annually
Borough of Collegeville
491 E. Main Street
Collegeville, PA 19426
610-489-9208 610-489-6661 Fax www.collegeville-pa.gov
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Plumbers Registration And Checklist 2017 (Borough of Collegeville)

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Completed 14 July 2020

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