License Service Order Request
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Email
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Please Choose Profession
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Medical
Osteopathic
Nurse
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Do you currently live in a compact state?
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AL-Alabama
AZ-Arizona
CO-Colorado
CT-Connecticut
DC-District of Columbia
DE-Delaware
FL-Florida
GA-Georgia
GU-Guam
HI-Hawaii
IA-Iowa
ID-Idaho
IL-Illinois
IN-Indiana
KS-Kansas
KY-Kentucky
LA-Louisiana
MD-Maryland
ME-Maine
MI-Michigan
MN-Minnesota
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MS-Mississippi
MT-Montana
ND-North Dakota
NE-Nebraska
NH-New Hampshire
NJ-New Jersey
NV-Nevada
OH-Ohio
OK-Oklahoma
PA-Pennsylvania
RI-Rhode Island
SD-South Dakota
TN-Tennessee
TX-Texas
UT-Utah
VT-Vermont
WA-Washington
WI-Wisconsin
WV-West Virginia
WY-Wyoming
Are you currently participating in IMLC?
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Yes
No
IMLC Eligible States
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Please Select
AL-Alabama
AZ-Arizona
CO-Colorado
DC-District of Columbia
DE-Delaware
FL-Florida
GA-Georgia
GU-Guam
HI-Hawaii
IA-Iowa
ID-Idaho
IL-Illinois
IN-Indiana
KS-Kansas
KY-Kentucky
LA-Louisiana
MD-Maryland
ME-Maine
MI-Michigan
MN-Minnesota
MO-Missouri
MS-Mississippi
MT-Montana
ND-North Dakota
NE-Nebraska
NH-New Hampshire
NJ-New Jersey
NV-Nevada
OH-Ohio
OK-Oklahoma
RI-Rhode Island
SD-South Dakota
TN-Tennessee
TX-Texas
UT-Utah
WA-Washington
WI-Wisconsin
WV-West Virginia
WY-Wyoming
*Connecticut, Pennsylvania, and Vermont are not considered “States of Principle Licensure, and are not eligible for IMLC Conversion.
If not, are you applying for IMLC conversion?
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Choose State(s):
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AK- Alaska
AL-Alabama
AR-Arkansas
AZ-Arizona
CA-California
CO-Colorado
CT-Connecticut
DC-District of Columbia
DE-Delaware
FL-Florida
GA-Georgia
GU-Guam
HI-Hawaii
IA-Iowa
ID-Idaho
IL-Illinois
IN-Indiana
KS-Kansas
KY-Kentucky
LA-Louisiana
MA-Massachusetts
MD-Maryland
ME-Maine
MI-Michigan
MN-Minnesota
MO-Missouri
MS-Mississippi
MT-Montana
NC-North Carolina
ND-North Dakota
NE-Nebraska
NH-New Hampshire
NJ-New Jersey
NM-New Mexico
NV-Nevada
NY-New York
OH-Ohio
OK-Oklahoma
OR-Oregon
PA-Pennsylvania
RI-Rhode Island
SC-South Carolina
SD-South Dakota
TN-Tennessee
TX-Texas
UT-Utah
VA-Virginia
VT-Vermont
WA-Washington
WI-Wisconsin
WV-West Virginia
WY-Wyoming
My Products
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Individual License (fee per license)
Service fee per licenses up to 3
$
525.00
Quantity
1
2
3
Item subtotal:
$
0.00
Elite Bronze 4 -10 licenses (fee per license)
Service fee per licenses up to 10
$
525.00
Quantity
4
5
6
7
8
9
10
Item subtotal:
$
0.00
Elite Silver 11 - 20 licenses (fee per license)
Service fee per licenses up to 20
$
500.00
Quantity
11
12
13
14
15
16
17
18
19
20
Item subtotal:
$
0.00
Elite Gold 21 -34 licenses (fee per license)
Service fee per licenses up to 34
$
475.00
Quantity
21
22
23
24
25
26
27
28
29
30
31
32
33
34
Item subtotal:
$
0.00
Elite Platinum 35+ licenses (fee per license)
Service fee per licenses up to 34
$
450.00
Quantity
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
Item subtotal:
$
0.00
IMLC Conversion
$
525.00
Quantity
1
Item subtotal:
$
0.00
Additional IMLC State (fee per license)
$
165.00
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
Item subtotal:
$
0.00
License Renewal (fee per state)
$
150.00
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
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21
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30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
Item subtotal:
$
0.00
License & CME Maintenance
$
400.00
Quantity
1
2
3
4
5
6
7
8
9
10
Item subtotal:
$
0.00
DEA License / CS Registration
$
150.00
Quantity
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
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24
25
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27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
Item subtotal:
$
0.00
FCVS Set Up
$
150.00
Quantity
1
Item subtotal:
$
0.00
FCVS Retrieval
$
100.00
Quantity
1
Item subtotal:
$
0.00
CAQH
$
125.00
Quantity
1
Item subtotal:
$
0.00
Notary
$
75.00
Quantity
1
Item subtotal:
$
0.00
Payment Methods
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