Service Training Order Form

Name

Title

Organization

Phone Number

Email Address

Product Option

Module 1: Essential Customer Service Training
($1,499.00)

Module 1: Enhanced Customer Service Training
($5,000.00)

Module 2: Essential Revenue Cycle Training
($1,499.00)

Module 2: Enhanced Revenue Cycle Training
($5,000.00)

Additional Product
(Module 1)

Package of 25 additional participant workbooks - $375.00 --- Quantity

One (1) additional facilitator guide - $100.00 --- Quantity

Additional Product
(Module 2)

Package of 25 additional participant workbooks - $375.00 --- Quantity

One (1) additional facilitator guide - $100.00 --- Quantity

Where did you find out about this product?

Payment Options

Please Invoice Me

Credit Card (enter credit card information below)

Credit card

Cardholder name

Card number

Expiration date

Cardholder's Signature

(Type in your name, which will be taken as your signature.)

Shipment Method

Address 1

Address 2

Address 3

City

State

Zip Code

Shipment Method

UPS Ground (3-5 day delivery) - $20 per shipment

Fed ex overnight - $40 per shipment

We will charge IL sales tax and shipping. Tax exempt organizations needs to provide their sales tax exemption.

*All purchases on packaged training products are non-refundable.