Email or Phone Update Request Form

It is the responsibility of the licensee to report any change of email or phone number to the Board within 30 days of the change. Do not use this form to report a name change or address– please use the Name Change Form or the Change of Address Form.


Complete, scan and upload the fillable Email or Phone Update Request Form below:


Email or Phone Update Request Form

Select
Caret IconCaret symbol
Select
Caret IconCaret symbol

Privacy Notice|Report Abuse
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.