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:

Cell Phone:
Home Phone:
Business Phone:
Fax Number:
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 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:

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 $10 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.