SECTION 609 REPLACEMENT CREDENTIALS REQUEST

SECTION 609 REPLACEMENT CREDENTIALS REQUEST

Section 609 certification credentials are good for life. If you were Section 609 certified and obtained your credentials from MACS or IMACA and have lost them, you may obtain replacement credentials by reordering them. The search for your reprint request must be paid in advance. If you have applied to us for a reprint not in the MACS or IMACA databases, your deposit will be retained by MACS to pay for the search and other processing involved. We suggest that you do not apply to us for a reprint unless you are sure that you have been certified by either MACS or IMACA.

Please provide the following information PRINT CLEARLY:

Your Name:______________________________________________________________________

Home Address:___________________________________________________________________

City:__________________________________State:________Zip:__________________________

Phone Number:___________________________________________________________________ Email address:____________________________________________________________________ I give MACS permission to email me. Driver's License #:_________________________ Last Four of Social Security #: _________________________

EMPLOYER AT TIME OF CERTIFICATION

Company Name__________________________________________________________________ Company City/State: ______________________________________________________________ Approx. Year of Certification _____________ MACS ______ IMACA _____

CURRENT EMPLOYER

Company Name: _________________________________________________________________ Company Address ________________________________________________________________ City: _______________________________________________State:____________Zip:_________ Please include $10 fee for processing. Please mail with check or fax with credit card information to: MACS Worldwide P.O. Box 88 Lansdale, PA 19446 Phone: 215-631-7020 Fax: 215-631-7017 Email: info@

Check/MO# ___________________________________________for $_____________

Credit Card: Visa: ____MC: ___ AMEX: ___ Discover: ___

Card#: ________________________________Name on Card_______________________________

CVV2/Sec Code: ____________ (3 or 4 digit# on back of card) Exp. Date: ________

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