Contractor's Registration Application

State License Number*

DRIVER'S LICENSE NUMBER*

First & Last Name*

Business Name*

Billing Address, City, State & Zipcode*

Business Phone #: Cell #:*

Email Address*

If you would like to pay for your Contractor's License by credit or debit card, please fill out the information below. We will then run the card at City Hall and have your receipt available there or email you a receipt if you input your email address below.

Full Name on Credit Card*

Credit Card Type*

Visa

Mastercard

AMEX

Discover

Credit Card Number*

Expiration Date*

Security Code (Three Digits on Back of Card)*

Billing Zipcode for Card*

Signature*

Text Area

Date Field*

Dumas, TX

Contractor's Registration Application

Contractor's Registration Application

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City Hall

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