Duplicate License or Registration Certificate

Fee: $10

PayPal charges a $2 convenience fee. Your total will be $12.

You may also mail the .pdf copy of this form with payment; or a note with your name, license/registration number, with a $10 check or money order.

Checks/Money Orders are made payable to: NCBOESLPA
Mailing Address:
NCBOESLPA
PO Box 16885
Greensboro, NC 27416
Assistant Information
Your duplicate registration certificate will be mailed to the address on file.
Mailing Address*
The board has my most up-to-date mailing address that has a mail receptacle. I understand that it will be mailed to the address on file.
- Yes, I understand
Name*
Prefix First Middle Last
Registration Number*
Email (for PDF delivery)*
Please enter an email address to receive a copy of this completed form. This is not a copy of your license or registration certificate. The license or registration certificate will be mailed to the address on file.
Payment Information
Duplicate License Fee
Convenience Fee
Total
$0.00
Payment Method*

American Express
Discover
MasterCard
Visa
Maestro
Supported Credit Cards: American Express, Discover, MasterCard, Visa, Maestro
Card Number Expiration Date Security Code Cardholder Name

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Assistant Information