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2. Company Name*
4. Mailing Address*
6. City*
7. State*
8. Zip Code*
10. Phone*
12. Fax
14. Email*
16. Name of Individual Being Registered*
18. State Trade License Number*
20. The above information should be used to register for the following contractor type: *

    1. Backflow
    2. Electrical
    3. General
    4. Irrigation
    5. Mechanical
    6. Plumbing
22. Upload Trade License*
24. Upload Texas Driver's License*
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26. 1. Receive an email copy of this form.
27. Email address

    This field is not part of the form submission.

28. Submit

* indicates a required field