APPLICATION

CERTIFICATION MANUAL & STUDY-GUIDE REQUEST

DATE:
CREDIT COUNSELING AGENCY:
CONTACT PERSON:
TELEPHONE:
ADDRESS:
CITY:
STATE:
ZIP:
FAX:
E-MAIL:

AFFILIATION: A.I.C.C.C.A. N.F.C.C. A.A.C.C. INDEPENDENT:

REGISTRATION FEE - $195.00 PER ENROLLMENT (MANUAL STUDY-GUIDE AND EXAMINATION)

QTY. MANUAL STUDY-GUIDE AND EXAMINATION AT $195.00 EA.=
  WITHIN THE STATE OF FLORIDA ADD 6% SALES TAX =
  IF NON-PROFIT AGENCY, PLEASE INCLUDE TAX-EXEMPT #
QTY. RETAKE EXAMINATION AT $50.00 EACH =  
QTY. SHIPPING AND HANDLING AT $5.00 EACH =  
   
TOTAL ENCLOSED:
   
CHECK #

 

 

PLEASE LIST COUNSELORS NAMES AND SOCIAL SECURITY NUMBERS

1.   Name SS#
2. Name SS#
3. Name SS#
4. Name SS#
5. Name SS#
6. Name SS#
7. Name SS#
8. Name SS#
9. Name SS#
10. Name SS#
11. Name SS#
12. Name SS#
13. Name SS#
14. Name SS#
15. Name SS#
16. Name SS#
17. Name SS#
18. Name SS#
19. Name SS#
20. Name SS#

Please Print and Mail this form with your payment to:

National Institute For Financial Education Of America

9715 West Broward Boulevard #314, Plantation, Florida 33324

Phone: 800-561-9035 Fax: 954-472-8923