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Application Form : Jane Packer School Of Flowers NYC
Name Of Course .........................................................
Please enter Start date of Course......................................
Course Fee $ .................................... + NY Sales Tax
Please Charge My Credit / Debit Card
(Please Under line Card Type)
Mastercard / Visa
Card Number
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Start Date .............../............... Expiry date: .........../...........
Sec Code ...................(last 3 numbers on signature strip)
Card Holders Name .............................................................
Address..............................................................................
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................................... Zip Code........................................
Telephone.................................................
Fax .......................................................
Email ..................................................... Attendee's details if different from above Name ..............................................................................
Address...........................................................................
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.......................................................................................
................................... Zip Code.......................................
Telephone.................................................
Fax .......................................................
Email ..................................................... I have read and agree to the Terms & Conditions (provided by this HTML Link) attached to this request for a place on the above course. Signature ............................................................. Date .................................................................. |
Please print this application form and mail / fax to the address below Ensure that you read our Terms & Conditions before applying |
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Return To:
Jane Packer Inc Telephone: 212-754-1731
328 East 59th Street Fax 212 754 1720
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