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Snow Plow Application

Download, complete, and return your application by email or U.S. mail, along with all fees to:

Village of Middlefield
Attn: Snow Plow Applications
14860 N. State Avenue
Middlefield OH, 44062-1019

Pre-application question(s)? Send the Village a note.

Name*
First Last
Email*
Enter Email Confirm Email
Address*
Street Address Address Line 2 City State ZIP / Postal Code Country
Company
Phone Number*
Emergency Phone Number*
Include the Following with Your Application
Acceptable file formats: JPEG, TIF or PDF
List snowplow vehicles and license plate numbers.*
Upload proof of insurance for each snowplow vehicle.*
Drop files here or

Accepted file types: jpg, tif, pdf, Max. file size: 50 MB.
Attach copy of valid state driver’s license for each snowplow driver.*
Drop files here or

Accepted file types: jpg, tif, pdf, Max. file size: 50 MB.
Application Fee
Price:
Your Payment Information*

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name
Signed*
First Name Last Name
Date Signed*
MM slash DD slash YYYY

Include the Following with Your Application