NYS PC Order Form

Please call (800) 342-9856 with any questions. If you would prefer to print, complete and email or fax this form to our office, CLICK HERE to complete the PDF and email to nicole@weinbergpc.com or fax to (800) 354-3381.

NOTE: The PC Consent Form & Affidavit must also be complete and submitted to nicole@weinbergpc.com in order to process your NYS PC Order.