Enrollment Agreement (U1) – Wyatt Institute of Real Estate

Unit 1 Application

Class Information:

Enter Class Date(s):
Confirm Class Date(s):

* indicates REQUIRED fields below

Student Information:

Have you attended classes here before?* YesNo

Company Name:
First Name:*
Middle Name:
Last Name:*
Nickname: for class purposes
Social Security Number:*
Street Address:
City: State: Zip Code:
Home Phone:
Business Phone:
Fax Number:
Cell Phone:
Email Address:*
How did you hear about us?

Payment Information:

Payment Choices explained:

TUITION options:

Either FULL Amount (or) DEPOSIT will hold your seat in class; balance due before/at 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:

Book is 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 $8 for shipping fee.)

{option: Office Pickup} Come by the office to pick book up (no charge)

Book will be given first day of 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: *

Additional Notes to Office Manager (optional):

Acceptance of Terms and Policies:*

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

Yes, I understand the Terms and Policies as part of this agreement. I am keeping a copy for my records.
Yes, I understand #2 of the Terms and Policies require me to give timely notice or forfeit $250 if I do not show.