This form is no longer in use

Replacement Wallet Card

PLEASE NOTE: Requests for replacement wallet cards may take 8–10 weeks for processing.

Replacement Card Fee: $30.00
If paying by check, please contact us at acrequests@iccsafe.org and we will email you the paper form.

Exam Candidate Information:

First Name*

Middle Initial*

Last Name*

Address*

City*

State*

Zip Code*

Business Phone Number*

Ext

Home Phone Number*

Candidate Email Address*

Wallet Card Verification:

ICC Record Number*

Payment Authorization:

For your security, the Assessment Center elects to collect credit card information via telephone. If paying by credit card, please provide name on credit card and authorize purchase.

Name as it appears on credit card*

Authorize Credit Card

I authorize the Assessment Center to contact me to collect my credit card information via telephone*