Epps Insurance Training Programs

Course Registration

For

Residential Property Damage Estimating

(Please type or print)

Student Name: ___________________________________________________________

Street Address: ___________________________________________________________

City: _______________________________ State: ______________ Zip: ____________

Telephone #: (____) ____ - _____________ Fax Number: (____) ____ - _____________

Company Name: ___________________________ Contact: _______________________

Street Address: ___________________________________________________________

City: _______________________________ State: ______________ Zip: ____________

Telephone #: (____) ____- _____________ Fax Number #: (____) ____- ____________

Email Address: ________________________________________________________

Web site: _____________________________________________________

Course Selection:                                                               START DATE:

Residential Property Damage Estimating ( One Week) $695.00      ___ / ___/ ______

A registration fee of $350.00 must be submitted with your registration and will be applied to the course fee.  The registration fee will only be refunded in full for cancellations received 96 hours (4 days) prior to start date.  The balance of the course fee is due at the start of class.  Payment may be made by cash, money order, or company check.  Personal checks will be accepted if submitted at least 15 days prior to the course start date.

Amount Enclosed $ ___________ Signature: _____________________ Date: _________

·          EITP reserves the right to cancel any class.  All fees paid to EITP will be refunded or applied to a future course date at the discretion of the applicant.  EITP will not be responsible for fees or expenses pertaining to travel, lodging, or other related expenditures due to cancellation of classes.

P.O. Box 116703

Carrollton, Texas  75011-6703

(Fax) 972-492-3743 <> 1-888-838-4808 <> 972-394-1013