Form St-C 214-1 - Nonresident Contractor'S Application For Authorization To Perform
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ST-C 214-1 (REV.8/12)
This application is not to be construed
to discharge any obligation, bonded or
otherwise imposed by section 48-8-6
3
Only original bonds, signed & notarized
can be accepted. Bond not accepted for
contracts less than $10,000.
N
C
’
A
A
P
ONRESIDENT
ONTRACTOR
S
PPLICATION FOR
UTHORIZATION TO
ERFORM
Contract or Job Number: ________________________
Beginning Date of Activity:
STN:
Date of Release
(for Department use only):
Bond Number:
Name of Business:
Street Address:
City:
State:
ZIP Code:
Individual
Partnership
Corporation
Other
Type of Ownership:
Person For Whom Contract is to be Performed:
Street Address:
City:
State:
ZIP Code:
Job Location:
City:
County:
Type of Contract Work to be Performed:
Beginning Date:
Anticipated Date of Job Completion:
Total Cost of Contract:
In order for your application to be processed, please include the $10 registration fee and Bond at 10% of the
contract price.
Application must be completed in full and remittance enclosed
[ ] Cashier Check
[ ] Certified Check
Type of Remittance:
[ ] Postal Money Order
Signature ____________________________________
(Signature of Owner or Partners. If Corporation, Authorized Officer must sign.)
Printed Name _________________________________
Title _________________________________________
Email _______________________________________
Contact name _________________________________
Contact phone number __________________________
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Parent category: Financial