PBIA Digital Forms

ALL REQUIRED INTAKE INFORMATION MUST BE COMPLETED

Contractor License / Application Fee Number

Applicant First Name

Applicant Last Name

Email

Phone Number

DBA (Optional)

Type of Business

Effective Date

Business Street Address

County

City

State

Zip Code

Mailing address is same as business

Mailing Street Address

County

City

State

Zip Code

Is the Inspection Contact same as the Applicant Contact?

Inspection Contact First Name

Inspection Contact Last Name

Inspection Contact Email

Inspection Contact Phone

Years in Business

Industry Experience