Wall Street Instructors., Inc.

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Online Florida Pre-Licensing
Enrollment Order Form

Click on the Secure Area logo to find out more about using your credit card online.

Here's how to order City College's Self Study Course


1.	Please select which course you wish to enroll in.
	Check the box next to the course you wish to enroll in. You will have a chance to preview your order summary before it is finally processed. Please Note that you can only enroll in one course at a time, and each student must enroll separately.

Course - Please Select One		Price
Life incl. VA (2-14)	$	159.00
Health Agent (2-40)	$	159.00
Life incl. VA (2-14) and Health Agent (2-40)	$	159.00

To order your study manual: http://naifa-florida.org/study-manuals/

Shipping and Billing Information

2.	Bill my account for these purchases.

Card/Account Number		/ Expiration Date
Credit Card Account Holder Name OR Wall Street Instructors Account Name
Privacy Statement We respect your privacy. All information provided to Wall Street Instructors will remain strictly confidential and will be used only for the intended purpose. We do not sell, rent or exchange our information for marketing or commercial purposes.


3.	What is your mailing address ?
	All necessary forms will be sent to the following person and location. If you ordered a Study Manual, it will be shipped UPS. We need a street address, no PO Boxes. You should receive your manual in 2 - 3 business days.

Name

Firm Name

Address

City

State

Country

Zip Code

Phone
(including area code)

Fax
(including area code)

Email

Date of Birth

Social Security #
(


4.	Course Login Information ?
	Please enter your desired username and password. You will use this login information to access your online course.


Username
Password


5.	Special instructions and additional information.
	Please enter any special instructions or additional information about your order.

Code
6.	Proceed to the next screen to Verify your Selections.
	When you click the "Verify Selections" button your chosen items will be listed. Nothing is processed or billed until you preview your invoice. The buttons on this page do not process any billing..

REFUND POLICY
10 day Refund Period � If in the first 10 days after enrollment, a student wishes to cancel the enrollment and return all study materials in usable condition, a full refund will be made for study materials (less a 10% re-stocking charge). Online courses are not refundable. Tuition, study materials, shipping and handling are not refundable after the initial 10 day refund period. Call (954) 764-0254 if you wish to arrange a cancellation and refund.

Phone: (954) 764-0254