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| Applicant
Name: |
Date of Birth: |
| Street
Address: |
Soc. Sec. #: |
| City,
State, Zip |
E-mail address: |
| Phone: |
Employer: |
PLEASE SELECT YOUR PROGRAM CHOICE
(MTRM200, HANA200, MTRN300, MCOD400)
(prices for book packages listed below):
CORRESPONDENCE PROGRAM PRICES:
Receive 5% discount
on program and book costs when you make full payment with your enrollment!
_____ Medical Terminology (MTRM200) - $995
plus $319 for book package (add $30.00 for shipping) - $1344 less discount $67
Total
- $1277
_____ Human Anatomy (HANA200) - $995
plus $167 for book package (add
$30.00 for shipping) - $1192 less discount $60
Total - $1132
_____ Medical Transcription (MTRN300)- $995 plus $352
for book package (add $30.00 for shipping) - $1377 less discount $69
Total - $1308
_____ Medical Records Coding (MCOD400) - $995
plus $561 for book package (add $30.00 for shipping) - $1586 less discount $79
Total - $1507
PAYMENT PLANS FOR CORRESPONDENCE PROGRAMS:
INITIAL PAYMENT DUE
WITH ENROLLMENT.
FINAL PAYMENT DUE WITHIN NINE WEEKS OR NINE LESSONS (WHICHEVER COMES FIRST)
____ Medical Terminology
(MTRM200) - Initial payment - $846.50
____ Medical Terminology (MTRM200) - Final
payment - $497.50
____ Human Anatomy (HANA200) -
Initial payment - $694.50
____ Human Anatomy (HANA200)-
Final payment - $497.50
____ Medical Transcription
(MTRN300)- Initial payment - $879.50
____ Medical Transcription
(MTRN300)- Final payment - $497.50
____ Medical Records Coding (MCOD400) -
Initial payment - $1088.50
____ Medical Records Coding
(MCOD400) - Final payment - $497.50
CHECK or MONEY ORDER ENCLOSED: ______________
CREDIT CARD INFORMATION:
____________________________ (number)
______________ (exp.)
PLEASE MAIL TO: CENTRAL BUSINESS SCHOOL
PO BOX 1081
MARQUETTE MI 49855
Please allow three weeks for Central Business School to
process your order. For questions, e-mail
Central Business
School.
APPLICANT SIGNATURE: ____________________________
DATE: ____________________________
My
signature here acknowledges that I have read and understood the "Tuition
Agreement" below.
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Tuition Agreement:
The
certificate program packages are assembled at the time of the order to provide
the student with the most current materials. Please allow 2 to 3 weeks for your
program package to be ready for shipment. All enrollments are confirmed by
email or phone call. All tuition and fees paid by the applicant shall be
refunded if the applicant is rejected by the school before enrollment. An
application fee of not more than $25.00 may be retained by the school if the
application is denied. All tuition and fees paid by the applicant shall be
refunded if requested within three business days after signing a contract with
the school. All refunds shall be returned in 30 days. Certificate and
transcript are awarded upon successful completion of each program. Allowable
completion time: One year from date of enrollment.
Full payments reflect a 5% discount on
program and book prices.
Payment plan available on
most programs -
pay as little as 50% of program cost
plus books to get started.
Make the initial half payment plus book costs and receive the entire program package.
Pay the remaining 50% of the
program
cost within 9 weeks or at completion of Lesson 9 (1/2 of the program), whichever comes
first.
Certificate and transcript awarded upon successful completion of each
certificate program.
Free
job-seeking assistance
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NOTICE OF
CANCELLATION
Enter date
of transaction:
You may cancel this transaction, without
penalty or obligation, within 3 business days from the above date.
To cancel this transaction, mail or deliver a signed and dated copy of this
cancellation notice or any other written notice.
I hereby cancel this transaction:
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