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 by 3pm on the Thursday before class begins.
    • Credit Card is required for all ONLINE submissions.
    • Checks, Cash, and Money Orders accepted at the 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 $10 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
    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 #2 of the Terms and Policies require me to give timely notice or forfeit $75 if I do not show.