Fax
Number: 731-254-9558
RELEASE OF INFORMATION AUTHORIZATION/REQUEST FOR REACTIVATION/TRANSFER
OF TEST SCORES
Once you have completed all
of the information below you may mail, email or fax the request to us.
Please send a copy of my Net test scores to:
______________________________________________________________
(Name &
Office of College or Business)
______________________________________________________________
(Complete Street Address)
______________________________________________________________
(City, State, & Zip Code)
Date test taken: ________________________
Your name when test was
taken: _____________________________
Social Security Number: _________________________________
Current Phone Number: _________________________________
_____________________________________ __________________
(Signature) (Date)
FOR OFFICE USE ONLY:
Date Mailed: ______________________________________
Date Test Scores Activated: __________________________