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 » —Please choose an option—>> 2023 Schedule <<No Broker 3A neededMar 6th - 9th, 2023Sep 5th - 8th, 2023 » CONFIRM Brokerage Management Confirm » —Please choose an option—>> 2023 Schedule <<No Broker 3A neededMar 6th - 9th, 2023Sep 5th - 8th, 2023 ■ Brokerage Exam Prep (3B) Select » —Please choose an option—>> 2023 Schedule <<No Broker 3B neededApr 3rd - 7th, 2023Oct 2nd - 6th, 2023 » CONFIRM Brokerage Exam Prep Confirm » —Please choose an option—>> 2023 Schedule <<No Broker 3B neededApr 3rd - 7th, 2023Oct 2nd - 6th, 2023 * 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: —Please choose an option—ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY Zip Code: Cell Phone: Home Phone: Business Phone: Fax Number: Email Address:* How did you hear about us? —Please choose an option—Internet/WebSocial MediaFormer StudentREALTOR®Wyatt SignWord of MouthNewspaperYellow PagesVoice MailOther 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 PAYMENT CHOICE : **read* 'Payment Choices explained' above, then select one$700 - Both Classes (dont send Unit 3-B book prior to class)$710 - Both Class Tuitions + Send Unit 3-B Book$345 - Unit 3-A Class Only (there is no book for this class)$355 - Unit 3-B Class (dont send book prior to class)$365 - Unit 3-B Class + Send Unit 3-B book prior to class)$150 - Both Class Deposit (dont send Unit 3-B book prior to class)$205 - Both Class Deposit + Send Unit 3-B book prior to class)$195 - Both Class Deposit + I will pickup Unit 3-B book prior to class)$130 - 3-B Class Deposit + Send Unit 3-B Book$120 - 3-B Class Deposit + I will pickup book prior to class$75 - One Class Deposit only - (dont send book prior to class) CHARGE to Credit Card: *choose one:VISAMasterCard «« 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 $75 if I do not show.