Application for Contractors

Did you include your State License?

About the Owner

Type of Business:

If your Business is a Corporation or a Partnership, list names of each partner or officer:

Is this application for a new business?
Have you ever operated a business in another name?

If yes, list name of business and location:

THE CITY OF DIAMONDHEAD RESERVES THE RIGHT TO HAVE AN INVESTIGATION DONE ON SAID INDIVIDUAL AND/OR BUSINESS TO VERIFY INFORMATION ON THIS APPLICATION.

AFFIDAVIT

I do solemnly swear that the information given above is true and correct to the best of my knowledge. This information is subject to audit by the City of Diamondhead and any person who willfully makes any false statement on an application for a License shall be subject to revocation of License(s) issued.

Applicant's Signature:

Printable Form