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| Replacement Certificate Order Form |
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As required by the CILB, we provide written Completion Certificates to all seminar attendees. Our Completion Certificates are distributed to the seminar attendees at the seminar site. We are not required to provide free replacements for lost Completion Certificates.
Also as required by the CILB, we report all seminar attendance to the CILB online database within 5 days of the day of the seminar, which means that the CILB does have a record of your attendance.
You DO NOT need a copy of your Completion Certificate to renew your license. Therefor, you would only need a replacement copy if your were being audited by the CILB (highly unlikely) OR you were reinstating an inactive license.
We keep a complete record of all seminar attendance, which includes copies of all Completion Certificates, the record of the attendance data uploaded to the CILB, and the original Seminar Sign-in Sheet.
Replacement Certificates, including a copy of the original Certificate, the upload roster, and the original sign-in sheet, are provided for $25.00 per seminar.
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| Contact Information |
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| Your Name: |
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| Company Name: |
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| Address: |
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| City: |
State:
Zip Code:
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| Phone: |
Alternate Phone: (optional) |
| E-mail: (Very Important) |
Thank You! |
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| Replacement Completion Certificate #1 $25.00 each |
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| Attendee Name |
Please enter exactly as printed on your license. |
| License Number |
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| Seminar Location |
City or Hotel Name. |
| Seminar Date |
Month and Year is sufficent. |
| Seminar Title |
QuickBooks, Estimating, Building Code, etc. |
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| Replacement Completion Certificate #2 $25.00 each |
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| Attendee Name |
Please enter exactly as printed on your license. |
| License Number |
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| Seminar Location |
City or Hotel Name. |
| Seminar Date |
Month and Year is sufficent. |
| Seminar Title |
QuickBooks, Estimating, Building Code, etc. |
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| To pay by Credit Card |
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| Total Order Amount: |
Please select the total dollar amount to be charged.
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| Card Type: |
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| Card Number: |
Please enter as XXXX XXXX XXXX XXXX
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| Exp. Date: |
Please select Month & Year
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| Name on Card: |
Cardholder Name (not the bank name) |
| Card Billing Address: |
Same as company address entered at top.
PLEASE NOTE: If the cardholder's billing address is the same as the company address entered above, then you DO NOT need to re-enter it again below. Thank You |
| Cardholder Mailing Address: |
Credit Card Billing Address |
| Billing Address City: |
State:
Zip Code:
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| To pay by Check |
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| Name on Check: |
(So we can apply the check to your order)
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Mail Check
Payable To: |
ProBuilder Seminars, Inc.
Post Office Box 1446
Longwood, FL 32752 |
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| Additional Information |
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Please enter any additional information.
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