Dunlap-Stone Univesity

Enrollment Agreement

-- Electronic Signature--

 

Please Sign and 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 you electronic signature as you signature for future courses.

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 December 10, 2009