City of Bedford
Public Works Department
1813 Reliance Parkway
Bedford, TX 76021
Phone:817.952.2200
Fee: $100.00
PUBLIC WORKS
CONTRACTOR REGISTRATION APPLICATION
Year:
Registration
20
Company Name
Owner/Officer of the Company
Title
(Officer of the company e.g., President, Vice President, CEO.) This person will be held responsible for seeing that all work being performed under this
registration is completed and in compliance with City codes and ordinances. Please attach a current Legible (text and picture) copy of this person's driver's
license, or if the owner or officer does not possess such a valid driver’s license then such other identity card or document issued by the federal or state
Government containing the picture and signature of said person.
Mailing Address
Suite
City
Zip
Physical Address
(if different)
Suite
City
Zip
Email Address
Business Phone
Alternate
Phone #1
Alternate
Phone #2
CONTRACTOR TYPE
Drivers
License #
Texas State
License #
Texas State
License #
PLEASE LIST THOSE WHO WILL HAVE AUTHORITY TO OBTAIN PERMITS IN YOUR COMPANY NAME
Print Name
Contact Phone
Signature
Date
Registration begins January 01 and ends December 31
PUBLIC WORKS
$2500 Bond Required
Additional Information
click to sign
signature
click to edit
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