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Contractor/Tradesman Registration



WASHINGTON PARISH CONTRACTOR/TRADESMAN REGISTRATION

 

 



 

REGISTRATION # WPCR_______________

 

Name of Business _____________________________________________________________

 

 Address of Business_____________________________________________________________

  

Phone # _______________________________

  

Name of

Owner________________________________________________________________

 

Address of Owner______________________________________________________________

Phone#___________________________________________

 

Type of Business________________________________________________________________

  

Parish Occupational License #_____________________________________________________

  

Proof of Liability Ins.____________________________________________________________

  

Proof of Workmans Comp.________________________________________________________

 

State Licensed____________________________________________________________

License Type___________________________________________________________________

 

I the undersigned do hereby attest that the above information is true and valid as of this date:

 

SIGNATURE OF OWNER OR AUTHORIZED REPRESENTATIVE:

 

 ____________________________________________________  

DATE:__________________

 

Attach copies of all documents presented for verification.

This registration is valid from January 1 to December 31.

ANNUAL FEE $50.00