Enrollment Agreement (3B) Video

Broker B Application Video

Class Information:

Enter Begin Class Date:
Confirm Begin Class Date:


* indicates REQUIRED fields below

Student Information:

Have you attended classes here before?* YesNo






Social Security Number:*








Payment Information:

Payment Choices explained:

TUITION options:

  • FULL Amount must be paid to begin VIDEO class.
  • Credit Card is required for all ONLINE submissions.
  • Checks, Cash, and Money Orders accepted at the office or by mail.

TEXTBOOK options:

  • Book and materials are included in price of class and are not returnable.
    • {option: Mail Book/Materials} We will mail book and materials to the address provided on this form.
      (includes $22 for shipping fee.)
    • {option: Office Pickup} Come by the office to pick up book and materials (no charge)

PAYMENT CHOICE : *
CHARGE to Credit Card: * «« VISA or MasterCard ONLY
Card #: *
3-digit security code: *
Expiration Date (MM/YY): *

Name on Card: *
Billing Address Number (used to process credit card): * (numbers ONLY)
Billing Zip Code: *


Acceptance of Terms and Policies:*

(check both boxes below to accept, after reading the Terms and Policies)

, I understand the Terms and Policies as part of this agreement. I am keeping a copy for my records.
, I understand #3 of the Terms and Policies that no refund is due once the course materials are mailed or given to me.