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Subcontractor Register Renew

Trucker/Supplier Register Renew

Illinois Department of Transportation
Subcontractor Registration Form

Please Note: Fields marked by an asterisk are mandatory

Please Fill out the form, then click on the "Submit" button

*Firm Name
*Firm Address

*City				*State				*Zip

*Contact First Name			Contact MI			*Contact Last Name

*Tax ID Type	Select One FEIN SSN			*Tax ID

*Contact Phone		Fax		*Email

*Annual Gross Revenue
*Date Firm Established
*Form of Organization	Select One Sole Proprietorship Partnership Corporation Limited Liability Company Other
*Owner Number 1		Owner Number 2
Owner Number 3		Owner Number 4
Owner Number 5		Owner Number 6

*Minority Status	Select One DBE NON-DBE

*Race of Majority Owner	Select One American Indian or Alaskian Native Asian Black or African American Hispanic or Latino Native Hawaiian or Other Pacific Islander White

*Gender of Majority Owner	Select One Male Female Unspecified or Another Gender Identity

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*Work Categories (select all that apply)
Aggregate Bases and Surfaces
Cold Milling, Planing and Roto Milling
Concrete Construction
Cover and Seal Coats
Demolition
Drainage
Earthwork
Electrical
Erection
Fencing
Guardrail
Installation of Raised Pavement Markers
Landscaping
Painting and Cleaning
Pavement Markings
Pavement Patching
Sawing Cutting
Seeding & Sodding
Signing
Soil Stabilization and Modification
Steel, Reinforcement (Rebar Placement)
Traffic Control
Tree Trimming and Selective Tree Removal
Vegetation Spraying
Other

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		* I certify the information provided is correct and true to the best of my knowledge.