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 » ---No Broker 3A neededSep 4th - 7th, 2018 » CONFIRM Brokerage Management Confirm » ---No Broker 3A neededSep 4th - 7th, 2018 ■ Brokerage Exam Prep (3B) Select » ---No Broker 3B neededOct 1st - 4th, 2018 » CONFIRM Brokerage Exam Prep Confirm » ---No Broker 3B neededOct 1st - 4th, 2018 * 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: ---ALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWY Zip Code: Home Phone: Business Phone: Fax Number: Cell Phone: Email Address:* How did you hear about us? ---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 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 & will be given at class time. To get a head start, you can request the book for 3B before class: We will mail book to the address provided on this form. (Include $7 for shipping fee.) -- OR -- Come by the office to pick book up (no charge) *Take note: there is no book for the 3A class PAYMENT CHOICE : **read* 'Payment Choices explained' above, then select one$635 - Both Classes (dont send Unit 3-B book prior to class)$642 - Both Class Tuitions + Send Unit 3-B Book$310 - Unit 3-A Class Only (there is no book for this class)$325 - Unit 3-B Class (dont send book prior to class)$332 - 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)$197 - Both Class Deposit + Send Unit 3-B book prior to class)$122 - 3-B Class Deposit + Send Unit 3-B Book$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 #3 of the Terms and Policies require me to give timely notice or forfeit $75 if I do not show.