REE-045-17
Rev. 07/2020
IREC use only
License #:
__________________________
Receipt #
: __________________________
Approved:
__________________________
CERTIFIED LICENSE,
EDUCATION HISTORY, AND
PRINTED LICENSE REQUEST
575 E. Parkcenter Blvd., Suite 180
Boise, Idaho 83706
Offi ce: (208) 334-3285
Fax: (208) 334-2050
licensing@irec.idaho.gov
irec.idaho.gov
NOTE: Requests are processed in the order received. Please allow up to 10
business days to process your completed request. Updates on the status of
these requests will NOT be given over the phone.
• Certifi ed license histories include the initial date of licensure, expiration date, status, and exam date(s).
• Certifi ed education histories include the licensee’s entire education record.
• Printed licenses are only available for active status licensees (individuals/companies).
Please provide a certifi ed license and/or education history and/or printed license for:
________________________________________________________________________________________
Name of Licensee (individual or company) License No.
Type of History Price each Quantity Total
Certifi ed License History $10
Certifi ed Education History $10
Printed License $15
Total
Please mail the document(s) to:
Name: __________________________________________________________________________________
Address: ________________________________________________________________________________
City: __________________________________ State: ______________________________ Zip: __________
Signature: __________________________________________________ Date: ________________________
Refund Policy - Because of rising costs associated with issuing a refund, it is the policy of IREC to refund overpayments
of under $25 only if requested in writing within 30 days of IREC receipt of the overpayment. Overpayments of $25 or more
will be automatically refunded. There is a $20 fee assessed for each check returned to IREC for insuffi cient funds.
Charge to: AMEX MC DISCOVER VISA
Card Number Exp. Date
Name as it appears on card: ________________________________________________________________
Billing Address (if diff erent from above): _______________________________________________________
City: _______________________________________ State: ______________________ Zip: ____________
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