Request Certification Reinstatement Form

Submitted by JCAttamack on Mon, 04/07/2025 - 11:25

Please complete this form to request the NC Well Contractors Certification Commission reinstate your certificate.

Well contractors requesting certification reinstatement must have complied or completed all requirements set forth by the WCCC Disciplinary Committee prior to certification reinstatement.

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First Name

Last Name

Email Address

Well Contractor Certification Number

NCWC

Type of Suspension

Suspension Expiration Date

I understand I must have compiled or completed all requirements set forth by the WCCC Disciplinary Committee prior to certification reinstatement.

I have read, understand and completed this form.

Electronic Signature

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