REQUEST FOR EXAMINATION APPOINTMENT

Name: _______________________________________________________________

Social Security Number: __________________________________________________

Address: _____________________________________________________________

City: ________________________________ State: _______ Zip: __________

I would like to request an refrigeration contractor examination on one of the following dates (please make three choices):

_____ Commercial Refrigeration Examination

_____ Transport Refrigeration Examination

1. _____________________________________________________________________

2. _____________________________________________________________________

3. _____________________________________________________________________

Note – An applicant shall receive credit for the passage of each part of the examination. Such credits shall be valid only for the next two succeeding attempts within a period of one year from the date the first part passed is taken. After three attempts within one year, any credit previously earned is no longer valid.

A person who fails a qualifying examination or any portion must wait a period of five business days from the date he last failed an examination before he will be eligible to retest.