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Certificate Request Form. This is a Nevada form and can be use in State Bar Statewide.
Tags: Certificate Request Form, Nevada Statewide, State Bar
THE STATE BAR OF NEVADA
Membership Records
600 E. Charleston Blvd. ▪ Las Vegas, NV 89104-1563
(702) 317-1430 ▪ suzannew@nvbar.org
Certificate Request Form
(Please use a separate request form for each member)
MEMBER INFORMATION:
MEMBER FULL NAME:
MEMBER BAR NUMBER:
REQUESTOR INFORMATION:
Contact Name:
Phone: (
)
-
E-mail:
Send Certificate(s) to this address:
Firm/Company Name:
Address: _________________________________________________________________________________________
City:
State:
Zip:
+
ORDER INFORMATION:
(There is a fee of $25 for each certificate ordered payable at the time of request)
□
□
□
Please send me a certificate of good standing from the State Bar of Nevada. Number of copies:
Please send me a certificate of good standing from the Nevada Supreme Court. Number of copies:
Please send me a disciplinary letter in addition to a certificate of good standing. (There is no charge for this letter)
Please be aware that both types of certificates are ordered through the State Bar of Nevada; however a certificate from the Nevada Supreme Court
is mailed to the requestor from the Supreme Court. (Allow 5-7 days for delivery for this certificate). Disciplinary letters come from the State Bar only.
PAYMENT INFORMATION:
□ Pay By Credit Card
□ Discover
□ Amex
□ Visa
Card #:
□ MasterCard
Expires (MM/YY:
Name on Card:
Address: ______________________________________________________________________________________
City:
State:
Signature:
Zip:
+
Date:
□ Pay by Check: Make check payable to (The State Bar of Nevada).
SHIPMENT INFORMATION:
(Regardless of shipment method chosen, requests for certificate(s) require at least five business days for processing unless otherwise noted).
□ Please mail my certificate(s).
□ Expedite
□ Please send my certificate(s) by overnight mail. I have enclosed a
prepaid overnight return envelope/air bill.
□ Please send my certificate(s) by overnight mail and charge my FedEx account:
Account #:
FAX CREDIT CARD
ORDERS TO:
Membership Records
702-382-2075
OR MAIL TO:
State Bar of Nevada
Membership Records
600 E. Charleston Blvd.
Las Vegas, NV 89104-1563
For State Bar of Nevada Use Only: ______ / ______ / ______
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