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.