Enrollment Agreement (Broker)

Broker Application

Class Information:

Brokerage Management Classes: 8:30AM - 4:40PM Choose Options for each (4) boxes below▼
Brokerage Management (3A) Select »
» CONFIRM Brokerage Management Confirm »
Brokerage Exam Prep (3B) Select »
» CONFIRM Brokerage Exam Prep Confirm »

* indicates REQUIRED fields below

Student Information:

Have you attended classes here before?* YesNo






Social Security Number:*








Payment Information:

Payment Choices explained:

TUITION options:

  • Either FULL Amount (or) DEPOSIT will hold your seat in class; balance due first day of class.
  • Credit Card is required for all ONLINE submissions.
  • Checks, Cash, and Money Orders accepted at main office or by mail.

TEXTBOOK options:

  • Materials included in price
  • To get a head start, you can request the book before class: (recommended)
    • {option: Mail Book} We will mail book to the address provided on this form. (includes $7 for shipping fee.) -- OR --
    • {option: Office Pickup} Come by the office to pick book up (no charge)
    • *Take note: there is no book for the 3A class
  • Book will be given at class, if {option: At Class} is selected

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 require me to give timely notice or forfeit $75 if I do not show.