Contractor Application

BASIC LICENSE APPLICATION

Please print.

Section 1 – All applicants

What is your Business’s legal structure? Sole Proprietor Business/General Partnership Limited Partnership Limited Liability Partnership Limited Liability Company Corporation S-Corporation Nonprofit

If your Business’s legal structure is Sole Proprietor, complete Sections 1, 2, and 4. If your Business’s legal structure is NOT Sole Proprietor, complete Sections 1, 3, and 4.

Business Information

Legal Name of Business

(The Legal Name that you provide must be exactly as filed with the County Clerk or New York State Secretary of State.)

Business’s Trade or Doing-Business-As (DBA) Name, if applicable

(The DBA Name that you provide must be exactly as filed with the County Clerk or New York State Secretary of State.)

Business Address (Building Number, Street Name, Unit, e.g., Floor, Suite) City and State ZIP Code Borough (check one):

01-Manhattan 02-Bronx 03-Brooklyn 04-Queens 05-Staten Island 08-Outside NYC

Country Business Telephone Number Fax Number E-mail ( ) ( ) Federal Employer Identification Number New York State Sales Tax Identification Number or (EIN) Certificate of Authority Application Confirmation Number (Mandatory for corporations, partnerships, and sole (You must complete this section if “Sales Tax Identification proprietors with paid employees) Number” is a requirement on your license application checklist/Business Express Description Page.)

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The Sales Tax Identification Number is the 9, 10, or 11-digit number on your New York State Department of Taxation and Finance Certificate of Authority. If you have not received your Certificate of Authority, please enter the 6-digit confirmation number you received when you successfully submitted the application for a Certificate of Authority.

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Contact Mailing Information

If you want DCA correspondence addressed and mailed to a contact other than the business name and address provided on page 1, please...