Request for Duplicate Credential Certificate

Instructions

Ordering Process

Credential Certificates

Breining Institute provides a display-worthy Certificate to new credential holders, upon the initial issuance of each new credential, at no extra charge to the credential holder, which is sent to the credential holder by U.S. Postal Mail or equivalent service.

Upon each renewal of the credential, which is due every two years, Breining issues a handsome PDF electronic-version certificate by email to the renewed credential holder.

Duplicate Certificate

Breining issues the “display-worthy” version of the credential only upon initial issuance of the credential.

If an individual credential holder wishes a duplicate of the original certificate, with a current renewal date displayed, Breining will be pleased to provide such, upon receipt of the Request for Duplicate Credential Certificate form and $75 processing fee payment for each certificate ordered.

Processing

Duplicate Certificates are processed once per month, typically mid-month. Thus, it will typically take from 3 to 6 weeks before we have completed our archive search, created a new certificate, and submitted it to the U.S. Post Office (or other carrier) for delivery to you.

PLEASE NOTE: The Office of the Registrar takes responsibility for handling duplicate certificate requests in a prompt and efficient manner. However, we are not responsible for mishandling by the U.S. Post Office or other shipping agencies.

Credential Holder Info

Credential Holder Information

Full Name: *

Other names (if applicable) under which the certificate(s) may have been issued:

Last four digits of your Social Security Number *

Date of Birth *

Email Address: *

Confirm Email Address: *

Primary Phone Number *

Certificate Info

Duplicate Certificate(s) Requested

Special Instructions (if any)

Please advise if there are special instructions, such as requesting more than one copy of a certain Credential.

Shipping of the duplicate Credential certificate to addresses within the United States is included, at no extra cost. There will be additional charges for shipping to addresses outside of the U.S., which will be charged to the credit card if you give us authorization to do so here.

Address and Payment Info

Address Information

Where do you want the certificate(s) sent?

We will send the requested certificate(s) to the mailing address you identify within this section. We will send them by regular First Class mail, using the U.S. Postal Service (USPS). If you desire expedited service, you may select the USPS Priority Mail option when completing the Payment Information, below.

Name *

Street address (include Apt or Suite number, if applicable) *

City: *

State / Province: *

ZIP Code or Country Code:

Country:

Country (if not the United States):

Payment Information

Order *

Select the number of certificate(s) you are ordering:

$75: I am ordering ONE (1) certificate to be sent via regular First Class USPS mail to the person and address identified above.

I am ordering more than one certificate to be sent via regular First Class USPS mail to the person and address identified above. I authorize a charge to my credit card of $75 for each certificate ordered.

Optional expedited shipping:

$40: Add this charge to send my certificate(s) via USPS Priority Mail to the person and address identified above.

You give permission to and authorize Breining Institute is authorized to charge the total amount of the item(s) selected, above, to the following credit card:

Credit Card: *

VISA

MasterCard

Discover

Credit Card Number: *

Credit Card Expiration Date *

Full Name on Credit Card: *

Are you ready to submit your request?

PLEASE NOTE: Duplicate Certificates are processed once per month, typically mid-month. Thus, it will typically take from 3 to 6 weeks before we have completed our archive search, created a new certificate, and submitted it to the U.S. Post Office (or other carrier) for delivery to you.

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