1715 Flat Top Road
Post Office Box 638
CoolRidge, WV 25825-0638
Phone: (304) 787-4398 Toll Free: (877) 609-9869 Fax: (888) 792-3905
Email: rtboard@wv.gov

Change of Address or Change Employer Form

It is the Licensees responsibility to provide the Board Office with accurate and updated information related to addresses and employers. 

Please utilize this Change of Address or Change of Employer Form to update your information.  This form is only for change of address or change of employer and cannot be used for name change purposes.

Note:  You must complete all mandatory information marked with an astarisk (*). 

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