EXAM ORDER FORM
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Upon completion of the course, we have a mandatory exam, which must be taken in order to receive a certificate of completion from the school. This is required in order for us to evaluate your skills and for you to use our school name as your training resource in obtaining employment. Please complete and mail this form back to us along with the appropriate fee. You may also fax this form or order your exam via our web site. Exam fee: $89.00 + $8.00 processing fee. Fee is subject to increase without notice. * You may also order online at www.caimedicaltranscription .com - Click on the Exam Order on the navigation bar on our home page.

QUANTITY _________ Exam #1__ Exam retake__
@ $89.00 ea. ________
Processing fee $8.00 _______________
Total Enclosed _______________

Send check/money order to:
CAI Medical Transcription - 116 Stillwater Road- Barnegat, NJ 08005
Or Fax to - 1-(609) 698-6544

CREDIT CARD/DEBIT CARD INFORMATION

Name as it appears on credit card: ____________________________________

Address as it appears on credit card billing statement:

______________________________________________

______________________________________________

Credit card: Visa ___ MC ___ Discover ____ Debit ____

Credit card #: __________________________________________

Expiration Date: ___________

Phone: _________________

Student # _______________

Email address where you would like exam delivered: _____________________________

Since your exam results will be physically mailed to you, if you have a change of address, please update it below: _________________________________________

__________________________________________

*********PLEASE ALLOW UP TO 7 DAYS FOR EMAIL DELIVERY***********