Plumber Registration Form for Private Lateral Rehabilitation Rebate Program

Plumber Registration Form for Private Lateral Rehabilitation Rebate Program - City of St. Petersburg

This form is intended to help inform the City of St. Petersburg on the latest contractor information. This form does not guarantee participation in the Private Lateral Rehabilitation Rebate Program.
Name*

First NameLast Name
Company Name*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Is your contact information correct and up-to-date on the City's Building Department list?*

Yes, my contact information is correct and up-to-date on the City's Building Department listNo, my contact information is incorrect and/or not up-to-date on the City's Building Department list
Please select all services you are licensed for and have the ability to do:*

CCTVOpen-cut replacementLining
Please download and complete a Form W-9 from the IRS website. The form can be found here.

Please note that the information filled out in the Form W-9 and gathered for this Program will only be used for the Program. It will not be shared unless required by law and information will be redacted as necessary. The completed form can be uploaded below.
Upload completed Form W-9*

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Plumber Registration Form for Private Lateral Rehabilitation Rebate Program - City of St. Petersburg