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If you would like your Renewal ID, please fill in the following information and
someone from DOPL will contact you. If you do not have the information, please
call the Division of Occupational and Professional Licensing at: (801) 530-6628
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I declare under penalty of perjury and as an authorized authority, that I am associated
with this business entity. By typing your name in the indicated field, you are agreeing
to conduct business electronically with the State of Utah in accordance with the federeal
Electronic Signatures in Global and National Commerce Act (E-Sign), 15 U.S.C.A. ? 7001-7031
(Supp. 2001) and Utah's Uniform Electronics Transactions Act (UETA), Utah Code Ann.
? 46 4-101 to -501 (2000). Understand that transactions and/or signatures in records
may not be denied legal effect solely because they are conducted, executed, or prepared
in electronic form, and that if a law requires a record or signature to be in writing,
an electronic record or signature satisfies that requirement.
Your Name:
(sign by typing your name in the box)
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