General Information

License Renewal Information

Application Type*

License Type*

License Class/Class Type*

License Number*

License Expiration Date

Applicant Information

Applicant Information is auto-populated from your DOB NOW profile. To update the name, address or phone number, select the person icon at the top right corner of the screen and select Manage/Associate Licenses. If changes are required, do not save this application until the Applicant Information is updated.

Email*

First Name*

Middle Initial

Last Name*

Business Name*

Business Address*

City*

State*

Zip Code*

Business Telephone*

Home Phone*

Mobile Phone*

Additional Information

Are you a Special Electrician for a NYC Agency ?*

Yes

Agency Name*

Are you including Foremen in the License Renewal?*

Yes

Enter the total number of Foremen included in the License Renewal* (Maximum:100)

Provide Foremen Details*

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Endorsement Information

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Comments

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