AUTHORIZED SIGNATURE
FOR AMOUNT PAYMENT METHOD USED (i.e., Credit Card, Check,
PO# ):_________________________________________
I
AGREE TO PAY THE ABOVE TOTAL AMOUNT ACCORDING TO THE
CARD ISSUER AGREEMENT FOR THE ABOVE LISTED CREDIT CARD
and/or FOR THE PURCHASE NUMBER (PO#) LISTED ABOVE.
ALL SALES ARE FINAL. NO REFUNDS. I
AGREE TO ALL GUIDELINES, POLICIES, AND PROCEDURES OF
COMMBASE TECHNICAL SOLUTIONS, LLC PRIOR TO ANY COURSE
ATTENDANCE.
Course Date
Selected:___________ Course Date
Scheduled:___________ Class/Receipt Confirmation:____________________
Attendee Confirmed :____________
STUDENT NAME:___________________________________
ADDRESS:_______________________________________
TELEPHONE#:_________________________
CELL#:______________________
FAX#:_________________________
E-MAIL:_________________________________
COMPANY NAME: _______________________________________ADDRESS:______________________________________
TELEPHONE#:__________________________
CELL#:______________________
FAX#:__________________________
E-MAIL:_________________________________
(Internal
Use Only)
Payment
& Registration Processed:
Fax Order_____ Telephone Order_____
e-Commerce_____
Marketing
Rep ID#:______________________ Telephone/Cell#:____________
/____________ Email:____________________
Course#:____________
Date Completed:_______________ Approved
Spiff/ID#:_________________
CommBase
Technical Solutions, LLC |
Attn:
Training Department |
2360
Corporate Circle *
Suite 400 *
Henderson NV *
89074 |
Tel:
(702) 785-7720, ext. 1003 *
Fax: (702) 947-6713 *
Email: enroll@compbasetraining.com |