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: .........../...........

Cec 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

Return To:

Jane Packer Inc                       Telephone: 212-754-1731

328 East 59th Street                 Fax 212 754 1720

New York , NY 10022 212 75 Email: flowerstore@janepacker.com