Online Course Registration Form

Please provide the following contact information:

 

*Last 5 digits of SS#:

*First Name

Middle Name

*Last Name

Jr./Sr./etc

*Street Address

*City

*State/Province

*Zip/Postal Code

*Home Phone

   (999-999-9999)

Work Phone

   (999-999-9999)

Cell Phone

    (999-999-9999)

Fax Number

   (999-999-9999)

*E-mail

(Existing users provide original email and password.)
*Password (Do not use # in your password.)
*Confirm password
   

*Course You Are Registering For:
(Your 10% discount will be applied if choosing more than one course. Please call our office for more course combinations.)

*Payment Method

VisaMastercardAmerican ExpressDiscoverPayPal

*Company Affiliation
(if applicable)

Name of person paying if other than yourself:

Type of Study:

    Comments:

 

Please scroll to bottom of page to submit form.

Refund, Check, and Course Completion Policy

  • There will be a $25.00 returned check charge on all checks returned.

  • Any refunds will be subject to a 10% administrative fee deducted from the return.

  • There will be no refunds on self-study courses where passwords have been provided - no refunds on books, computer programs, or other material purchased.

  • If a student has had no activity in their course for a period of 6 months, we will consider them inactive and their course will be terminated.

  • I understand I should not schedule my state exam until I have recieved my examination admission ticket. I also understand under no circumstances will The Agent's Choice PLE School take responsiblity if I am unable to attend the state exam because I do not have my examination admission ticket.
Accept Refund Policy

Once you submit this form you will be directed to our payment options.  

If you wish to pay by credit card, you will be directed to checkout through Paypal.  If you choose to pay by cashier's check, money order, or cash you will receive access to the curriculum through a link sent via email when your payment is processed.

All of our credit card payments are processed securely through PayPal