PAYMENT TEST ONLY – TEST FOR LIVE PAYMENTS Applicants Name* Email* Billing Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone*Tuition and FeesTuition* Price: Registration Fee* Price: Total $0.00 Cancellation and Refund Policy The school must refund all money paid if the applicant is not accepted. This includes instanceswhere a starting class is canceled by the school. The school must refund all money paid if the applicant cancels by midnight of the third business day after signing the contract (Enrollment Agreement). The cost of material, equipment, books and uniforms provided to the student may not be refunded unless the items and materials in question are returned in “as new” condition. The school may retain one hundred dollars and the $100 Registration Fee and the cost of anyequipment, uniforms, books and material that is not returned in as new condition, if the applicantcancels after the third business day after signing the contract. Refunds are made according to the percentage of clock hours of classes attended and anymaterials, equipment, books and uniforms that is not returned in “as new” conditions. Effective date of termination for refunds purposes is the earlier of the last date of attendance or receipt of written notice of termination. Refunds are provided within 30 days of termination. The $100 application and background check fee, also known as Registrations fee,are not refundable under any circumstances. The cost of materials, equipment, books and uniforms provided to the student may not be refunded unless the items and materials in question are returnedin “as new” condition. Refunds will be prorated according to the amount of class time attended up t0 50%. No refund will be issued after completion of 50% of the course program. Applicant’s SignatureDate Credit Card American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Month010203040506070809101112 Year20242025202620272028202920302031203220332034203520362037203820392040204120422043 Expiration Date Security Code Cardholder Name