CORPORATE SALES

Online Training - Corporate Billing Account Application

CID: __2618__

CORP: _________

ACCT CODE: _________

I request an Online SchoolRoom business account authorization code for online training courses. I understand that completion of this application will result in my company/organization receiving an authorization code that my employees can use to access training courses via a computer with modem/Internet access anytime anywhere. 

After processing this application, Online SchoolRoom will issue my company an authorization code. I understand that it is my responsibility to inform current/prospective employees of this code and that I am responsible for payment of all courses taken by trainees via this code. Invoices/Payment will be processed by 360training.com. 

Please type/print the following information.  Allow 5 days for processing.  Authorization codes will only be given to the contact person listed on this form and is subject to change. 

SALES REPRESENTATIVE:   __________________________________________________

COMPANY NAME: __________________________________________________    

CHECK TYPE OF BUSINESS: 0 Sole Proprietorship0 Corporation 0 Government

- Federal Employer Identification No. or Local State Taxpayer:      

PAYMENT METHOD OPTIONS (Check One):

0 Credit Card: (Your credit card will be charged within 5 business days of the following month)

Type:Please Select

Number:    

Exp. Date (mm/yy):      /     

Name on Card:    

0Purchase Order   (Statements sent 10th of each month; payment due net 10) 

P.O. Number:    

CONTACT INFORMATION

- Contact Person   _____________________________________________________    

- Mailing Address: ______________________________________________________    

- City/State/ZIP:    ______________________________________________________      

- Tel:(     ) -  ___________________________________   

- Fax:(     ) - ___________________________________    

- E-Mail:     ____________________________________

PURCHASE ORDER BILLING INFORMATION

- Contact Person  ______________________________________________________    

- Mailing Address: ______________________________________________________    

- City/State/ZIP:   _______________________________________________________

- Fax:(     ) -  ______________________________________________   

- Contact Persons Signature: __________________________________________________

Please Email and/or Fax this form to support@classroom-on-line.com Fax 888.742.6518