Lost Certification Form

Lost Your Certificate? Get it Replaced

Complete this form to start the process. NOTE: There is a $50 reprint fee, payable via credit card or paypal.

"*" indicates required fields

C-Tech Certificate Replacement*

This fee will cover replacements for ALL certifications you ever earned

Price:

Name*

First Middle Last Suffix

Address*

Street Address Address Line 2 City State ZIP Code

Primary Email*

Alternate Email

Phone*

Date of Birth*

Name of School/Facility you trained at

Instructor's Full Name

Which certificates did you lose?*

Wireless

Telecommunications Technologies

Network Cabling: Copper

Network Cabling: Fiber Optics

Telephone Systems & VoIP

Audio/Video Entertainment

Energy Management

Ground & Bonding: Copper Connectivity Systems

What year did you get your certification?

Please estimate if the exact year is unknown

Certification Number (if available)

Please provide (1) Certification Number, located on the bottom-right of your Certification

Choose your payment method*

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

Total

Lost Certification Form

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