DEPARTMENT OF TRANSPORTATION
CONTRACTS SECTION
(860) 594-3129
"NOTICE TO CONTRACTORS" SUBSCRIPTION
APPLICATION FORM
FEE: ONE HUNDRED THIRTY DOLLARS ($130.00)
PLEASE CHECK ONE:
FIRST TIME SUBSCRIBER
PREVIOUS SUBSCRIBER, RENEWAL
FIRM'S NAME ______________________________________________________________________
STREET ADDRESS___________________________________________________________________
POST OFFICE BOX NUMBER ___________________________________________________________
CITY/TOWN ________________________________________________________________________
STATE____________________________ ZIP CODE_________ - _________
TELEPHONE NO._(___)_____________________________FAX NO._(___)_______________________
NAME OF PERSON TO RECEIVE NOTICE __________________________________________________
CHECK NO.________________________ MONEY ORDER NO. ______________________
AMOUNT $ ________________________
FIRM'S FORMER NAME, IF ANY ________________________________________________________
FORMER ADDRESS _____________________________________________________________________
PLEASE MAKE CHECK OR MONEY ORDER PAYABLE TO:
"TREASURER, STATE OF CONNECTICUT"
MAIL TO: |
CONNECTICUT DEPARTMENT OF TRANSPORTATION |
CONTRACTS SECTION, ROOM 1318 | |
2800 BERLIN TURNPIKE | |
P.O. BOX 317546 | |
NEWINGTON, CONNECTICUT 06131-7546 | |