:::Alabama Real Estate Schools:::

You may submit your registration payment information via this form by clicking the "Online Submission" button at the bottom of this page or...

You may print out this registration form and mail / Fax to our main office

Billing Information:
Must be the billing address where your credit card statements are sent

First Name:

Middle:

Last Name:

Company:

Street Address:

City:

State:

Zipcode:

Country:

Evening Phone:

Alt. Phone:

Fax:

Please provide full area code and number.

Account Information:

1. Must provide a valid e-mail address for instant electronic confirmation.
2. The system will send your billing statement and account information.
3. Your password must be AT LEAST 8 alphanumeric characters in length.

Email:

Email (Confirm):

Password:
(for online & computer courses)

Password(Confirm):

Year of your birth?

Credit Card Information:

We accept VISA and MC:

Name on Card:

Credit Card Number:		Exp Date: (month/year)

CVS Number: * last 3 numbers on the back of card

Course Registration:

Please select which course you would like to register for.

Course (Click arrow to choose Course):

Social Security Number:

License Number (For All Courses Except Salesperson Pre-License & Investor Course):

License Issue Date (Post License Courses Only):

Please post any dates/locations/comments/questions, etc.

Your credit card will be charged a one-time fee, appearing on your statement as GREENLEAF and/or DEARBORN/CAREER WEB SCHOOL/KAPLAN.