Form Submission Complete

2. HAULER/CONTRACTOR INFORMATION
4. APPLICATION STATUS*

   1. New Application
6. BUSINESS TYPE*

   1. Corporation
   2. Partnership
   3. Sole Proprietorship
8. BUSINESS NAME:*
10. ADDRESS:*
12. CITY:*
13. STATE:*
14. ZIP:*
16. PHONE:*
17. FAX:
18. EMAIL ADDRESS:*
20. MAILING ADDRESS (if different from above):
22. CITY:
23. STATE:
24. ZIP:
26. NAME:*
27. CA CONTRACTOR LICENSE #:*
29. TITLE:*

    1. OWNER
    2. PRESIDENT
31. HOME ADDRESS:*
33. CITY:*
34. STATE:*
35. ZIP:*
39. CORPORATIONS/PARTNERSHIPS MUST PROVIDE THE FOLLOWING INFORMATION FOR EACH CORPORATE OFFICER, DIRECTOR, OR PARTNER:
41. NAME:
42. HOME ADDRESS:
43. PHONE #:
44. EMAIL:
46. LIST ALL OTHER NAMES UNDER WHICH YOUR BUSINESS OPERATES IN THE CITY OF HESPERIA:
50. VEHICLE AND YARD INFORMATION
52. NUMBER OF TRUCKS HAULING MATERIAL IN HESPERIA:*

    (Please list all vehicles below)

54. LICENSE PLATE:*
55. REGISTERED OWNER NAME:*
57. COLLECTION/MAINTENANCE YARD(S) ADDRESS(ES):*
59. I certify under penalty of perjury that the information provided with this application is all true and correct. I certify also that I have not withheld any information that would affect the outcome of this application.
61. Signature (Owner/President)*
62. Date*
64. Print Full Name*
65. Title*
Leave This Blank:


67. 1. Receive an email copy of this form.
68. Email address

    This field is not part of the form submission.

69. Submit

* indicates a required field