Dunlap-Stone Univesity | Enrollment Agreement Electronic Signature Form
Please PRINT, SIGN, then FAX this form to us. FAX: (602) 648-5755
I have read and agree to the terms and conditions of the Enrollment Agreement.
I affirm and confirm that the electronic signature shown below is my legal
signature for my Enrollment Agreement.
NOTE:
Once we have this form on file,
you only need use your electronic signature as your signature for future courses on Step 2 of the Enrollment Agreement.
STUDENT CHARGE INFORMATION
Student Name
Student Daytime Phone
Student Company / Employer
Amount to Be Charged
Course / Service Description
Electronic Signature
Student Signature
[___________________________]
Electronic Signature
[___________________________]
Date
[______/______/______]
FAX: (602) 648-5755
NOTE Your Enrollment Agreement can not be processed
until we have your signature on file.
EA January 20, 2011
After you PRINT, SIGN, DATE, and FAX this form, continue to Tuition Payment .