AUTHORIZED SIGNATURE
FOR AMOUNT PAYMENT METHOD USED (i.e., Credit Card, Check,
PO# ):_________________________________________
1 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 |
PO Box 82143 * Las Vegas, NV * 89189 |
Tel: (307) 773-0124 / (702) 785-7720, ext. 1003 * Fax: (702) 947-6713 * Email: enroll@compbasetraining.com |