FOR LICENSEE USE ONLY

This form allows licensees to review their business and contact information and submit changes to the Board office.  Use this form to notify the Board of any address change or to make a correction to information posted on the website.  Include your email in the message at the end of the form to receive a response regarding your submission.  The Board does not publish email addresses on the website and will only use them for official correspondence.  All changes requested will be verified prior to posting.