West Virginia State Board of Barbers and Cosmetologists
1201 Dunbar Avenue
Dunbar, WV 25064
Tel: 304.558.2924 Fax:304.558.3450
www.wvbbc.org
REQUEST FOR LICENSE CERTIFICATION
Please complete this form in its entirety. Incomplete forms will be rejected.
Please complete the information on this form. The license certification will be sent to the state board you indicate below. The processing time for completing this request is usally 1-2 weeks.

Requirement for Processing Include:
$35.00 processing fee
Completed Application
YOUR INFORMATION
SSN: License Number:
   
Name: License Number:
Address:  
City:   State:      Zip Code:  
County: Phone:  
 
STATE BOARD THAT WILL RECEIVE YOUR INFORMATION      
           
State Board Name:     Board Phone:  
Board Address:  
Board City:   State:       Zip Code: