ANNUAL RENEWAL FORM

Instructions

Be advised your application could be delayed if you use a 3rd party licensing organization. The Board cannot discuss your application information with anyone except the applicant. An affidavit from the processor is insufficient to discuss your licensing information.

LATE FEES:
Annual HVAC/Refrigeration Active Late Fees
Annual Renewal Fee    $220.00
After December 31      $470.00 = $250.00 late fee + $220.00 renewal fee

Annual HVAC/Refrigeration Inactive Late Fees
Annual Renewal Fee    $110.00
After December 31      $360.00 = $250.00 late fee + $110.00 renewal fee

Annual DATT Late Fees
Annual Renewal Fee    $50.00
After December 31      $100.00 = $50.00 late fee + $50.00 renewal fee

Annual Apprentice Fees
Annual Renewal Fee    $50.00

Screen Guide

Screen Layout

Reviewing Completed Application

Printing Application

Demographics

Last Name

Bludsworth

First Name

Wallace

Middle Name

License Number

1989378

Address Information

Address 1

820 E. ROY PARKER ROAD

Address 2

City

OZARK

State

Zip Code

36360

Contact Information

Home Phone

(334) 774-2951

Work Phone

(334) 714-2951

Email Address

[email protected]

Business Information (if applicable)

Business Name

Bludsworth Service Company

Address Information

Address 1

820 E. ROY PARKER ROAD

Address 2

City

OZARK

State

Zip Code

36360

Contact Information

Phone

Alternate Phone

Disclosures

Have you ever been convicted of or entered a plea of guilty or nolo contendere (no contest) to any felony including any offense for which you have received a pardon, in any jurisdiction in the past 12 months?

Yes

Citizenship

(Must be completed in compliance with Ala. Code § 34-14A-7 and Ala. Code § 31-13-7.)

Are you a citizen of the United States?

Yes

I hereby declare that I am a citizen of the United States of America and, I sign this declaration under penalties of perjury; making a false, fictitious, or fraudulent statement or representation in this declaration is perjury in the second degree pursuant to Ala. Code § 13A-10-102.

Signature of Applicant

Wallace C. Bludsworth

Date

11/15/2021

PROVIDE PROOF OF CITIZENSHIP i.e.: driver’s license, passport, birth certificate

View/Download

Pay and Submit

I understand that continuing education hours were completed after the November 1 due date and that an additional $25 continuing education deficiency plan fee is being added to my renewal

E-Signature

Wallace C. Bludsworthg

Date

11/15/2021

Fee

$190.00

Service Fee**

$7.60

Total

$197.60

Payment Type

Credit Card

Person`s Name on card

Wallace C. Bludsworth

Card Number

*****8482

Zip code

By checking this box and completing this electronic payment, you agree to our Terms and Conditions.

^**This Service Fee is for electronic payments made to the Authorizing Body through the Website. The Authorizing Body permits us to charge this Service fee. By checking the box and completing this electronic payment, you agree to pay the Service Fee.

Board charge, including a convenience fee, will appear on your statement with a description including IGOVSOL*