CAI Transcription Order Form

Mail or FAX to: CAI Transcription
79 S. Main St., Suite #8
Barnegat, NJ 08005
1-888-224-6590
FAX# (609)698-6881

ALL ORDERS ARE SHIPPED VIA UPS - FOR SHIPPING PURPOSES, PLEASE PROVIDE A PHYSICAL ADDRESS OTHER THAN A PO BOX.

*If choosing a payment plan, you may make down payment via check/money order, but be sure to provide a debit/credit card in order for us to secure subsequent payment plan payments*

ENROLLMENT APPLICATION

CREDIT CARD STATEMENT NAME AND BILLING ADDRESS

First Name:

Last Name:

Address 1:

Address 2:

City:

State:

Zip Code:

Country:

Email Address:

Home Phone:

Work Phone:

Social Security# required for pay plans & NJ Students:

SHIP INFORMATION:Check if Same

First Name:

Last Name:

Address 1:

Address 2:

City:

State:

Zip Code:

Country:

ENROLLMENT APPLICATION

If sending down payment via check/moneyorder, be sure to supply us with a valid credit/debit card # in the event of nonpayment of subsequent monthly payments. Should you submit monthly payments via check/moneyorder, be sure to facilitate receipt prior to your due date in order to avoid charges to your credit/debit card. If we receive payment via check/moneyorder after your due date and payment has already been processed via credit/debit card, a $20.00 processing fee will be charged in order to facilitate credit refund.

*NOTE: $100.00 DEDUCTION FOR PAY IN FULL ENROLLMENT

Please choose online or traditional (book/CD)

Type of Course:OnlineTraditional (Book/CD)

Complete Course - US Residents - $1830.00 + $25.00 s/h ($1730.00 if paid in full)

Payment Plan A - $915.00 x 2 payments - 1st payment $915.00 + $25.00 s/h - 2nd payment auto billed in 30 days - US residents only!

Payment Plan B - $885.00 down + $25.00 s/h - 2nd/3rd payment auto billed monthly - $482.50 x 2 - (includes one time $20.00 processing fee) - US residents only!

Flex Pay #3 - Three payments - $600.00 down + $25.00 s/h - 3 payments of $420.00 auto billed monthly - (includes $30.00 finance charge) - US residents only!

Flex Pay #6 - Six payments - $600.00 down + $25.00 s/h - 6 payments of $215.00 auto billed monthly - (includes $60.00 finance charge) - US residents only!

Career Choice Guide/Free Tape (US residents) - $55.00 + $5.00 s/h

Choosing Medical Transcription As A Home Business (complete guide to MT home business) included in course, but also offered separately (US residents) - $55.00 + $5.00 s/h

CHECKCREDIT CARD

Type of Credit Card:VisaMastercardAmerican ExpressDiscoverSallie Mae Loan (signature required)

Debit Card:Debit Card with Visa/Mastercard Logo Only!

Credit Card #:

Debit Card #:

Expiration Date:

Signature:_______________________________

Referral # (if any):

SUBTOTAL OF ORDER:

PAY IN FULL DISCOUNT ($100.00):

SHIPPING/HANDLING:

GRAND TOTAL:

Additional Comments/Shipping Instructions: