This Web Application may be used for both the class and the ASSE certification Exam. Payment for the ASSE Examination of $200.00 must be made payable to: S & M Water Consultants

Items marked with a * are required fields   Please use the "TAB KEY" to advance to next field.

Application Date *    

First Name *  Middle   Last* 

  Home: Street* 

Home City*    Home State*    Home Zip* 

Home Phone*               Email   

Company     Address  

City          State  Zip      

 Phone *       Fax    Date you wish to test 

 Certification:      Initial Certification    Re Certification  Repair Certification 

If Re-Certification: 

Certifying Agency Colorado ASSE ABPA   Certification#  Expiration Date   Initial Cert Date

Type of Certification Applying For:  Tester  Tester/Repair   Survey

List five years of Water related or Plumbing experience if applying for first time certification. If applying for re-certification this information is not necessary.

The section below MUST BE COMPLETED. ASSE REQUIRES THIS INFORMATION.

please call 719-593-7315 if you need help filling out this field.

 Form of payment  Check # Purchase Order #

Credit Card: Master Card Visa   You will be contacted for the card information.

IF application is for unscheduled class please complete the following as to when and where you would like a class.

Location:    Month you would like   Day   Evening    

If paying by credit card please call 719-593-7315 within 48 hours to relay information.

If you do not show for the exam or the class NO fees will not be refunded.

The total fee will be  $600.00 payable to S & M Water Consultants.   

 Special re-certification class will be $275.00    You will need to fax a copy of current certification,  if recertifing from another type of certification ie. ABPA, card to 719-535-8227                        

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