indicates required field.
Business Name: Include corporate name registered with Oregon Secretary of State and any DBAs and affiliates that will construct, own or control any facilities in the ROW.
Business Address:
City:
State: -Select State- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington Washington DC West Virginia Wisconsin Wyoming
Zip:
Email:
Phone: (format: 999-999-9999 or 10-digit number)
Extension:
Contact Name:
City Business License Number: (numbers only)
ROW License and/or Registration: ROWL (format: 9999)
Gross Revenue $
5% of the Revenues: $
Linear Feet:
You pay: $
Number of Poles:
Total Fee: $
Name:
Title:
Questions about whether the information you submit is private: please read the City of Beaverton Web Site Privacy Policy. Further questions about the City’s privacy policy: send an email to citymail@BeavertonOregon.gov.