Individual License Renewal


Name:  

Other Last Name(s) known by:  

Address:  

City:  

State:  

Zip:  

Home Phone:  

Cell Number:  

License Number:  

Place of Employment:  

Have you, in the past year, ever been convicted of an offense other than minor traffic violations?:  
If yes, please submit a written explanation including the nature of the offense, action taken, and a copy of the criminal judgment.

Renewal Fees

Please Select Duplicate (Second) License $10.00 + $15 Late Fee Esthetician Renewal $20.00 + $15 Late Fee Homebound Renewal $30.00 Manager Operator Renewal $20.00 + $15 Late Fee Manicurist Renewal $20.00 + $15 Late Fee Master Renewal $20.00 + $15 Late Fee Operator Renewal $15.00 + $15 Late Fee Instructor Renewal $20.00 + $15 Late Fee