Recertification Purchase Order

Recertification Purchase Order

Use this form to purchase vouchers for certificant holders recertifying through continuing education.
Date of Request

MonthDayYear
Date
Requestor Name

First NameLast Name
Company Name
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone
Email
example@example.com

Please specify the quantity for each type of recertification, in the correct column below.

	FP-C	CCP-C	TP-C	TR-C	CP-C	Total $
FP-C/CCP-C/CP-C/TP-C Recertification
$285 (Member rate)
$385 (Non-Member rate)
TR-C/MTSP-C Recertification
$175 (Member rate)
$195 (Non-Member rate)

Enter Total
Please fill in the names and email addresses of each certificant holder requesting Recertification.
Certificant Holder(s) Requesting Recertification
Certificant Holder(s) Requesting Recertification
Certificant Holder(s) Requesting Recertification
Within 2 -4 business days of IBSC receipt of this form, an invoice will be emailed to the requester named above.

Each certificant holder will receive an email including a voucher number and instructions for applying the voucher number in lieu of payment for recertification. Voucher numbers are nontransferable.

Contact the IBSC at help@IBSC.org or +1 (770) 978 4400 if you have questions or need assistance.
Main Office: 4835 Riveredge Cove

Snellville , GA 30039

+1 (770) 978-4400

www.IBSCertifications.org
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