{"id":1568,"date":"2015-11-10T12:55:28","date_gmt":"2015-11-10T20:55:28","guid":{"rendered":"http:\/\/www.breining.edu\/?page_id=1568"},"modified":"2026-02-22T11:52:16","modified_gmt":"2026-02-22T19:52:16","slug":"request-for-duplicate-credential-certificate","status":"publish","type":"page","link":"https:\/\/www.breining.edu\/index.php\/professional-certification\/request-for-duplicate-credential-certificate\/","title":{"rendered":"Request for Duplicate Credential Certificate"},"content":{"rendered":"<p class=\"p1\"><form method=\"post\" enctype=\"multipart\/form-data\" id=\"vfbp-form-7\" class=\"vfbp-form\"><div style=\"display:none;\"><label for=\"vfbp-EMAIL-AN8fuQyoDLXem\">If you are human, leave this field blank.<\/label><input size=\"25\" autocomplete=\"off\" type=\"text\" name=\"vfbp-EMAIL-AN8fuQyoDLXem\" value=\"\" id=\"\"><\/div><input type=\"hidden\" name=\"_vfb-timestamp-7\" value=\"1776002052\" id=\"\"><input type=\"hidden\" name=\"_vfb-form-id\" value=\"7\" id=\"\"><section class=\"vfb-page-section\"><h3 class=\"vfb-page-title\">Instructions<\/h3><div class=\"vfb-col-12 vfb-fieldType-page-break\" id=\"vfbField1941\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-instructions\" id=\"vfbField1940\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1940\" class=\"vfb-control-label\"><\/label><div class=\"\"><h3><span style=\"color: #800000;\">Credential Certificates<\/span><\/h3>\n<p>Breining Institute provides a display-worthy Certificate to new credential holders, upon the initial issuance of each new credential, at no extra charge to the credential holder, which is sent to the credential holder by U.S. Postal Mail or equivalent service.<\/p>\n<p>Upon each renewal of the credential, which is due every two years, Breining issues a handsome PDF electronic-version certificate by email to the renewed credential holder.<\/p>\n<hr \/>\n<h3><span style=\"color: #800000;\">Replacement Certificate<\/span><\/h3>\n<p>Breining issues the &#8220;original&#8221; credential only upon initial issuance of the credential.<\/p>\n<p>If an individual credential holder wishes a replacement of the original certificate, Breining will be pleased to provide such, upon receipt of the <strong>Request for Duplicate Credential Certificate<\/strong> form and $75 processing fee payment for each certificate ordered.<\/p>\n<p><strong>PLEASE NOTE: The replacement certificate will be produced in accord with the format currently used for Credentials issued by Breining Institute.<\/strong><\/p>\n<hr \/>\n<h3><span style=\"color: #800000;\">Prepare to provide documentation<\/span><\/h3>\n<p>Please be prepared to upload a copy of your original certificate, a copy of a government-issued ID card, and a recent photo of yourself.<\/p>\n<h3>Copy of Original Certificate(s) Upload<\/h3>\n<ul>\n<li>You will need to upload a copy or photo of each originally issued certificate that you wish to be provided.<\/li>\n<li>The copy or photo of the certificate must be clearly legible, so that we can identify the name of the person to whom it was issued, the date of issuance, and the Credential number<\/li>\n<\/ul>\n<h3>Government-issued ID Card Upload<\/h3>\n<ul>\n<li>You will upload a copy of an identification card which includes your photo, such as a drivers license or passport or similar ID card that is issued by a government agency.<\/li>\n<li>This ID card will be used for our internal identification verification purposes only.<\/li>\n<\/ul>\n<h3>Current Photograph Upload<\/h3>\n<ul>\n<li>You will upload a current photo of you.<\/li>\n<li>The photo may be taken using your smart phone or similar device.<\/li>\n<li>This photo will be used on our publicly-accessible website page that verifies the award of your credential(s).<\/li>\n<\/ul>\n<p>If you are unable to upload the certificate, ID or photo within this form, you may send them to us by email at College@Breining.edu<\/p>\n<hr \/>\n<h3><span style=\"color: #800000;\">Processing<\/span><\/h3>\n<p>Replacement Certificates are processed once per month, typically mid-month. Thus, it will typically take from 3 to 6 weeks before we have completed our archive search, created a new certificate, and submitted it to the U.S. Post Office (or other carrier) for delivery to you.<\/p>\n<p><span style=\"color: #800000;\"><strong>PLEASE NOTE:<\/strong> <\/span>The Office of the Registrar takes responsibility for handling replacement certificate requests in a prompt and efficient manner. However, we are not responsible for mishandling by the U.S. Post Office or other shipping agencies.<\/p>\n<\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/section><section class=\"vfb-page-section\"><h3 class=\"vfb-page-title\">Credential Holder Info<\/h3><div class=\"vfb-col-12 vfb-fieldType-page-break\" id=\"vfbField1942\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Credential Holder Information<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField178\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField182\"><div class=\"vfb-form-group\"><label for=\"vfb-field-182\" class=\"vfb-control-label\">Full Name: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-182\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-182\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField1953\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1953\" class=\"vfb-control-label\">Other names (if applicable) under which the certificate(s) may have been issued:<\/label><div><input id=\"vfb-field-1953\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-1953\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField1954\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1954\" class=\"vfb-control-label\">Last four digits of your Social Security Number <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-1954\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-1954\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField1955\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1955\" class=\"vfb-control-label\">Date of Birth <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-1955\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-1955\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-email\" id=\"vfbField191\"><div class=\"vfb-form-group\"><label for=\"vfb-field-191\" class=\"vfb-control-label\">Email Address: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-191\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"email\" name=\"vfb-field-191\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-email\" id=\"vfbField192\"><div class=\"vfb-form-group\"><label for=\"vfb-field-192\" class=\"vfb-control-label\">Confirm Email Address: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-192\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" data-vfb-equalto=\"#vfb-field-191\" type=\"email\" name=\"vfb-field-192\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-phone\" id=\"vfbField197\"><div class=\"vfb-form-group\"><label for=\"vfb-field-197\" class=\"vfb-control-label\">Primary Phone Number <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-197\" class=\"vfb-form-control vfb-intl-phone\" placeholder=\"\" required=\"required\" type=\"tel\" name=\"vfb-field-197\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/section><section class=\"vfb-page-section\"><h3 class=\"vfb-page-title\">Documentation<\/h3><div class=\"vfb-col-12 vfb-fieldType-page-break\" id=\"vfbField4160\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-instructions\" id=\"vfbField4168\"><div class=\"vfb-form-group\"><label for=\"vfb-field-4168\" class=\"vfb-control-label\"><\/label><div class=\"\"><h3><span style=\"color: #008000;\">If you are unable to upload the certificate(s), the ID or the photo, please send them to us by email at College@Breining.edu<\/span><\/h3>\n<\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-instructions\" id=\"vfbField4165\"><div class=\"vfb-form-group\"><label for=\"vfb-field-4165\" class=\"vfb-control-label\"><\/label><div class=\"\"><h3><span style=\"color: #800000;\">Copy of Original Certificate(s) Upload<\/span><\/h3>\n<ul>\n<li>You will need to upload a copy or photo of each certificate that you wish to receive.<\/li>\n<li>The copy or photo of the certificate must be clearly legible, so that we can identify the name of the person to whom it was issued, the date of issuance, and the Credential number<\/li>\n<\/ul>\n<\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-file-upload\" id=\"vfbField4166\"><div class=\"vfb-form-group\"><label for=\"vfb-field-4166\" class=\"vfb-control-label\">Certificate Upload<\/label><div><input id=\"vfb-field-4166\" class=\"vfb-form-control vfb-file-input\" placeholder=\"\" type=\"file\" name=\"vfb-field-4166\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-instructions\" id=\"vfbField4161\"><div class=\"vfb-form-group\"><label for=\"vfb-field-4161\" class=\"vfb-control-label\"><\/label><div class=\"\"><h3><span style=\"color: #800000;\">Government-issued ID Card Upload<\/span><\/h3>\n<ul>\n<li>Upload a copy of an identification card which includes your photo, such as a drivers license or passport or similar ID card that is issued by a government agency.<\/li>\n<li>The copy of the ID should be in PDF or JPG format.<\/li>\n<li>This ID card will be used for our internal identification verification purposes only.<\/li>\n<\/ul>\n<\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-file-upload\" id=\"vfbField4162\"><div class=\"vfb-form-group\"><label for=\"vfb-field-4162\" class=\"vfb-control-label\">Government-issued ID Card Upload<\/label><div><input id=\"vfb-field-4162\" class=\"vfb-form-control vfb-file-input\" placeholder=\"\" type=\"file\" name=\"vfb-field-4162\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-instructions\" id=\"vfbField4163\"><div class=\"vfb-form-group\"><label for=\"vfb-field-4163\" class=\"vfb-control-label\"><\/label><div class=\"\"><h3><a href=\"https:\/\/www.breining.edu\/wp-content\/uploads\/2024\/08\/photo-guidelines-200.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-full wp-image-33164\" src=\"https:\/\/www.breining.edu\/wp-content\/uploads\/2024\/08\/photo-guidelines-200.jpg\" alt=\"\" width=\"200\" height=\"164\" \/><\/a><br \/>\n<span style=\"color: #800000;\">Current Photograph Upload<\/span><\/h3>\n<ul>\n<li>Upload a current photo of you.<\/li>\n<li>Photo must be in color.<\/li>\n<li>Facing forward, look straight to the camera.<\/li>\n<li>No hats or sunglasses.<\/li>\n<li>The photo may be taken using your smart phone or similar device.<\/li>\n<\/ul>\n<p>This photo will be used on our publicly-accessible website page that verifies the award of your credential(s), and we will include it on your credential renewal certificate. In consideration of issuance of the credential referenced in this application, you expressly agree that the photo you submit and your likeness contained therein may be included in the Breining Institute &#8220;International Credential Verification (ICV) System&#8221; and posted on the credential verification pages of Breining Institute websites. By submitting the photo, you hereby release and discharge Breining Institute from any and all actions, claims and demands of any nature which you may have at any time now or in the future arising out of or related to the rights to the photo granted herein or your likeness.<\/p>\n<p><strong>Online Verification of Credentials<\/strong><\/p>\n<p>Current credential status may be verified online through the Breining Institute International Credential Verification System, Certified \/ Credentialed Counselors (CCCo), at this link: <a href=\"https:\/\/ccco.breining.edu\/\" target=\"_blank\" rel=\"noopener noreferrer\">https:\/\/ccco.breining.edu\/<\/a><\/p>\n<\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-file-upload\" id=\"vfbField4164\"><div class=\"vfb-form-group\"><label for=\"vfb-field-4164\" class=\"vfb-control-label\">Current Photograph Upload<\/label><div><input id=\"vfb-field-4164\" class=\"vfb-form-control vfb-file-input\" placeholder=\"\" type=\"file\" name=\"vfb-field-4164\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-instructions\" id=\"vfbField4167\"><div class=\"vfb-form-group\"><label for=\"vfb-field-4167\" class=\"vfb-control-label\"><\/label><div class=\"\"><h4><span style=\"color: #008000;\"><strong>If you are unable to upload the certificate(s), the ID or the photo, please send them to us by email at College@Breining.edu<\/strong><\/span><\/h4>\n<\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/section><section class=\"vfb-page-section\"><h3 class=\"vfb-page-title\">Certificate Info<\/h3><div class=\"vfb-col-12 vfb-fieldType-page-break\" id=\"vfbField1943\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Replacement Certificate(s) Requested<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField176\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField189\"><label for=\"vfb-field-189\" class=\"vfb-control-label\">Current Breining Credentials<\/label><div><span class=\"vfb-help-block\">Please select all Breining Institute credentials for which you are ordering a certificate. Credential must be current.<\/span><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-189-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-189\" type=\"checkbox\" name=\"vfb-field-189[0]\" value=\"1\">Registered Addiction Specialist (RAS)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-189-1\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-189\" type=\"checkbox\" name=\"vfb-field-189[1]\" value=\"1\">Registered Addiction Specialist - Level II (RAS II)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-189-2\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-189\" type=\"checkbox\" name=\"vfb-field-189[2]\" value=\"1\">Registered Addiction Specialist - Level III (RAS III)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-189-3\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-189\" type=\"checkbox\" name=\"vfb-field-189[3]\" value=\"1\">Masters Level - Registered Addiction Specialist (M-RAS)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-189-4\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-189\" type=\"checkbox\" name=\"vfb-field-189[4]\" value=\"1\">Clinical Supervisor Credential (CSC)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-189-5\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-189\" type=\"checkbox\" name=\"vfb-field-189[5]\" value=\"1\">Master Counselor in Addictions (MCA)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-189-6\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-189\" type=\"checkbox\" name=\"vfb-field-189[6]\" value=\"1\">Certified Women\\'s Treatment Specialist (CWTS)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-189-7\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-189\" type=\"checkbox\" name=\"vfb-field-189[7]\" value=\"1\">Medication-Assisted Treatment Counselor (MATC)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-189-8\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-189\" type=\"checkbox\" name=\"vfb-field-189[8]\" value=\"1\">Forensic Addiction Counselor (FAC)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-189-9\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-189\" type=\"checkbox\" name=\"vfb-field-189[9]\" value=\"1\">Certified Co-occurring Disorders Specialist (CCDS)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-189-10\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-189\" type=\"checkbox\" name=\"vfb-field-189[10]\" value=\"1\">Certified Case Manager Interventionist - Associate (CCMI-A)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-189-11\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-189\" type=\"checkbox\" name=\"vfb-field-189[11]\" value=\"1\">Certified Case Manager Interventionist (CCMI)<\/label><\/div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-189-12\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-189\" type=\"checkbox\" name=\"vfb-field-189[12]\" value=\"1\">Certified Case Manager Interventionist - Masters Level (CCMI-M)<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Special Instructions (if any)<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField198\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-textarea\" id=\"vfbField199\"><div class=\"vfb-form-group\"><label for=\"vfb-field-199\" class=\"vfb-control-label\">Please advise if there are special instructions, such as requesting more than one copy of a certain Credential.<\/label><div><textarea id=\"vfb-field-199\" class=\"vfb-form-control\" placeholder=\"\" rows=\"10\" name=\"vfb-field-199\" cols=\"50\"><\/textarea><span class=\"vfb-help-block\">Shipping of the duplicate Credential certificate to addresses within the United States is included, at no extra cost. There will be additional charges for shipping to addresses outside of the U.S., which will be charged to the credit card if you give us authorization to do so here.<\/span><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><\/section><section class=\"vfb-page-section\"><h3 class=\"vfb-page-title\">Address and Payment Info<\/h3><div class=\"vfb-col-12 vfb-fieldType-page-break\" id=\"vfbField1944\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Address Information<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField1945\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-instructions\" id=\"vfbField1946\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1946\" class=\"vfb-control-label\">Where do you want the certificate(s) sent?<\/label><div class=\"\"><p>We will send the requested certificate(s) to the mailing address you identify within this section. We will send them by regular First Class mail, using the U.S. Postal Service (USPS). If you desire expedited service, you may select the USPS Priority Mail option when completing the Payment Information, below.<\/p>\n<\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField1947\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1947\" class=\"vfb-control-label\">Name <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-1947\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-1947\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField1948\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1948\" class=\"vfb-control-label\">Street address (include Apt or Suite number, if applicable) <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-1948\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-1948\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField184\"><div class=\"vfb-form-group\"><label for=\"vfb-field-184\" class=\"vfb-control-label\">City: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-184\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-184\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField185\"><div class=\"vfb-form-group\"><label for=\"vfb-field-185\" class=\"vfb-control-label\">State \/ Province: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-185\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-185\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField187\"><div class=\"vfb-form-group\"><label for=\"vfb-field-187\" class=\"vfb-control-label\">ZIP Code or Country Code:<\/label><div><input id=\"vfb-field-187\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-187\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-select\" id=\"vfbField188\"><label for=\"vfb-field-188\" class=\"vfb-control-label\">Country:<\/label><div><div class=\"vfb-form-group\"><select id=\"vfb-field-188\" class=\"vfb-form-control\" placeholder=\"\" name=\"vfb-field-188\"><option value=\"United States\">United States<\/option><option value=\"Other\">Other<\/option><\/select><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField186\"><div class=\"vfb-form-group\"><label for=\"vfb-field-186\" class=\"vfb-control-label\">Country (if not the United States):<\/label><div><input id=\"vfb-field-186\" class=\"vfb-form-control\" placeholder=\"\" type=\"text\" name=\"vfb-field-186\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-form-group vfb-col-12\"><div><div class=\"\">Payment Information<\/div><\/div><\/div><div class=\"vfb-col-12 vfb-fieldType-heading\" id=\"vfbField173\"><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField1950\"><label for=\"vfb-field-1950\" class=\"vfb-control-label\">Order <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><span class=\"vfb-help-block\">Select the number of certificate(s) you are ordering:<\/span><div class=\"vfb-radio\"><label><input id=\"vfb-field-1950-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-1950\" value=\"$75: I am ordering ONE (1) certificate to be sent via regular First Class USPS mail to the person and address identified above.\">$75: I am ordering ONE (1) certificate to be sent via regular First Class USPS mail to the person and address identified above.<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-1950-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-1950\" value=\"I am ordering more than one certificate to be sent via regular First Class USPS mail to the person and address identified above. I authorize a charge to my credit card of $75 for each certificate ordered.\">I am ordering more than one certificate to be sent via regular First Class USPS mail to the person and address identified above. I authorize a charge to my credit card of $75 for each certificate ordered.<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-checkbox\" id=\"vfbField1951\"><label for=\"vfb-field-1951\" class=\"vfb-control-label\">Optional expedited shipping:<\/label><div><div class=\"vfb-checkbox\"><label><input id=\"vfb-field-1951-0\" class=\"\" placeholder=\"\" data-vfb-multiple=\"vfb-field-1951\" type=\"checkbox\" name=\"vfb-field-1951[0]\" value=\"1\">$40: Add this charge to send my certificate(s) via USPS Priority Mail to the person and address identified above.<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-instructions\" id=\"vfbField174\"><div class=\"vfb-form-group\"><label for=\"vfb-field-174\" class=\"vfb-control-label\">You give permission to and authorize Breining Institute is authorized to charge the total amount of the item(s) selected, above, to the following credit card:<\/label><div class=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-radio\" id=\"vfbField172\"><label for=\"vfb-field-172\" class=\"vfb-control-label\">Credit Card: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"vfb-radio\"><label><input id=\"vfb-field-172-0\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-172\" value=\"VISA\">VISA<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-172-1\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-172\" value=\"MasterCard\">MasterCard<\/label><\/div><div class=\"vfb-radio\"><label><input id=\"vfb-field-172-2\" class=\"\" placeholder=\"\" required=\"required\" type=\"radio\" name=\"vfb-field-172\" value=\"Discover\">Discover<\/label><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-number\" id=\"vfbField177\"><div class=\"vfb-form-group\"><label for=\"vfb-field-177\" class=\"vfb-control-label\">Credit Card Number: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-177\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"number\" name=\"vfb-field-177\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField196\"><div class=\"vfb-form-group\"><label for=\"vfb-field-196\" class=\"vfb-control-label\">Credit Card Expiration Date <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-196\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-196\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-text\" id=\"vfbField190\"><div class=\"vfb-form-group\"><label for=\"vfb-field-190\" class=\"vfb-control-label\">Full Name on Credit Card: <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><input id=\"vfb-field-190\" class=\"vfb-form-control\" placeholder=\"\" required=\"required\" type=\"text\" name=\"vfb-field-190\" value=\"\"><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-instructions\" id=\"vfbField1956\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1956\" class=\"vfb-control-label\">Are you ready to submit your request?<\/label><div class=\"\"><p>PLEASE NOTE: Duplicate Certificates are processed once per month, typically mid-month. Thus, it will typically take from 3 to 6 weeks before we have completed our archive search, created a new certificate, and submitted it to the U.S. Post Office (or other carrier) for delivery to you.<\/p>\n<\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-captcha\" id=\"vfbField1957\"><div class=\"vfb-form-group\"><label for=\"vfb-field-1957\" class=\"vfb-control-label\">Captcha <span class=\"vfb-required-asterisk\">*<\/span><\/label><div><div class=\"g-recaptcha\" data-sitekey=\"6LdWgN0UAAAAAM_hb1SqmzT2DP4J1X289K2epOVA\"><\/div><input type=\"hidden\" name=\"_vfb_recaptcha_enabled\" value=\"1\" id=\"\"><div class=\"vfb-has-error\" id=\"vfb-recaptcha-error\"><span class=\"vfb-help-block\">reCAPTCHA is required.<\/span><\/div><\/div><\/div><\/div><div class=\"vfb-clearfix\"><\/div><div class=\"vfb-col-12 vfb-fieldType-submit\" id=\"vfbField181\"><button id=\"vfb-field-181\" class=\" btn btn-primary\" placeholder=\"\" type=\"submit\" name=\"_vfb-submit\">Submit<\/button><\/div><div class=\"vfb-clearfix\"><\/div><\/section><\/form><\/p>\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":10,"menu_order":0,"comment_status":"open","ping_status":"open","template":"","meta":{"footnotes":""},"class_list":["post-1568","page","type-page","status-publish","czr-hentry"],"_links":{"self":[{"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages\/1568","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/comments?post=1568"}],"version-history":[{"count":8,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages\/1568\/revisions"}],"predecessor-version":[{"id":39792,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages\/1568\/revisions\/39792"}],"up":[{"embeddable":true,"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/pages\/10"}],"wp:attachment":[{"href":"https:\/\/www.breining.edu\/index.php\/wp-json\/wp\/v2\/media?parent=1568"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}