Waste Management License

2. 

4. 807 Mountain Avenue | PO Box 1229 | Berthoud, CO 80513 | O: 970-344-5801 | E: deputyclerk@berthoud.org

6. Date of Application:
   Date of Application:
8. Company Name:
9. Email Address*
11. Address
13. City
14. State
15. Zip Code
17. Phone Number
19. Owner of Business:
21. Name
22. Email Address
24. Mailing Address

    Mailing Address if different from the above.

26. City
27. State
28. Zip Code
30. Attached Proof of Certificate of Insurance:*

    Must not be expired.

32. Attach Colorado Department of Revenue Sales and Use Tax License:*

34. See Berthoud Municipal Code 14.7-2

    Application Fee: $250.00 payable to the Town of Berthoud by check or phone at 970-344-5801.

Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit Submit and Print

* indicates a required field