Barber License Exam - Prometric

Duplicate Score Report Request
1. The duplicate score report fee is $15 and must be paid with a credit card.
2. Enter all information requested. You should also keep a copy of this form for your own records.
Print or type clearly and neatly. Incomplete or illegible forms will not be processed.
Candidate Information
Last Name (at the time you took the exam) First Name Middle Initial Social Security Number
___ ___ ___-___ ___-___ ___ ___ ___
Street Address (including Apt. number or P.O. Box, if applicable)
City State ZIP Code Email Address
Daytime Phone Number (including area code)
( )
Title of Exam for which you want a duplicate score report
Business Phone Number (including area code)
( )
Date Exam was Taken
Complete the credit card information on the last page.
Fax this completed form to 800.347.9242 or mail this completed form to:
Prometric, ATTN: NJ Barber Duplicate Score Report
7941 Corporate Drive
Nottingham, MD 21236.
Rev 20130612 10