Form Center

2. Licensee Information

4. First Name*
5. Last Name*
6. Middle Initial
8. License Number
10. Current Home Address *
12. City*
13. State*
14. Zip Code*
16. Primary Phone*
17. Alternate Phone
19. E-mail Address*

21. Business Information (Optional information that would appear on your license certificate)

23. Business Name (if applicable)
25. Business Address
27. City
28. State
29. Zip Code
31. Business Phone

33. Acknowledgement

35. I acknowledge that I am the person who passed the approved exam and is listed on the license. Fradulent submissions will result in immediate recovation of your license. *
    -- Select One --YesNo

37. Payment

39. After you click on "Submit" or "Submit and Print", you will be redirected to the credit/debit card payment page. From this page choose "Make a One-Time Payment". At the next screen select "Electrical License Renewal" from the Payment Category drop-down box. We will send you the hard copy of your license in the mail using the current home address information supplied on this form.
41. Please Note: If you choose "Submit and Print", you must click the "Continue" button on the next page.
Leave This Blank:


42. Submit Submit and Print

* indicates a required field