Town Of Milton
525 Canton Ave
Milton , MA 02186
Phone: (617) 898-4925
   
Applicant Registration Form
Tell us about yourself     Homeowner       Contractor     
  ** Applicant Name   Lic #   ** Type   Expiration Date Open Calendar    
  ** Business Name   Lic #     ** Type   Expiration Date Open Calendar    
  W.Comp.Insurance Company Name   W.Comp.Policy Number   W.Comp.Policy Expiration Date Open Calendar    
  ** Applicant Name   Lic #   ** Type  Expiration Date Open Calendar    
   Business Name   Lic #      Type  Expiration Date Open Calendar    
  W.Comp.Insurance Company Name   W.Comp.Policy Number   W.Comp.Policy Expiration Date Open Calendar    
  ** Phone Number        ** Alt. Phone Number     
  ** Address
  ** City   ** State   ** Zip
  ** Email Address
Choose your User Name and Password
  ** Choose your User Name   Check your User Id
** Use only alpha characters and numbers. Do not use spaces, underscores, punctuations or special characters like /, \ , * in the User Name or the password. The name should not exceed 20 characters. 
  ** Enter your password
  ** Re-enter your password
  ** Pick a secret question
  ** Your secret answer
  Please Note : ** Indicates Mandatory Fields. 


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