Mailing List Request Form - Oregon Board Of Accountancy

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Oregon Board of Accountancy
3218 Pringle Rd SE #110
Salem OR 97302
OREGON BOARD OF ACCOUNTANCY
503-378-4181
MAILING LIST REQUEST FORM
ATTENTION: Attach/Include appropriate non-refundable fee with request. Please type or print clearly.
CONTACT INFORMATION OF REQUESTOR
Person Requesting Information:
Name of Organization:
Telephone Number:
E-Mail Address:
Mailing Address:
City and State:
Zip Code:
EXPLANATION OF INFORMATION INCUDED IN MAILING LIST
The cost to produce a list of the names and addresses of Certified Public Accountants (CPA) and Public Accountants (PA)
licensed in Oregon is $5.75. Payment is accepted by check, money order or Visa or MasterCard only.
SELECT ALL CATEGORIES TO BE INCLUDED IN THE LIST
Active CPAs
Inactive CPA
CPA Exam Candidates
Active PAs
Inactive PA
assed Exam
Registered Firms
Municipal Roster
SELECT DEMOGRAPHIC INFORMATION TO BE INCLUDED
Mailing Address (complete)
License Number
Date License Granted
Phone Number
Specific Counties:
Specific Cities:
Email
Oregon only
All Geographic Areas
New Licensees Only: please state
Firm / Business Association
Other Requested Information:
date range requested:
CREDIT CARD PAYMENT INFORMATION (VISA or MASTERCARD ONLY)
Credit Card Number:
Expiration Date:
Name on Credit Card:
Amount to Charge: $
Billing Address:
Billing Zip Code:
FORMAT OF MAILING LIST REQUESTED
E-Mail List to:
Pick up disk from Board Office
Send disk through US Postal Mail
Clerk:
Date Processed:
Seq #
Batch #
Last 4
Date List Sent:

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