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If you would like to fax in your order please use
the following form.
License Renewal
Enrollment
Please indicate the course(s) needed by placing
a check mark in the box to the left of the course(s): |
| Name: |
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| Email: |
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| Address: |
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| City: |
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| State: |
Zip: |
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D.R.E.
License I.D. # |
Expiration Date |
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| Day Phone: |
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| Fax: |
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| Referred by: |
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12-Hour Package: (1st time sales renewals
Agency, Ethics, Trust Funds, Fair Housing) |
$34 |
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Cost of Courses Ordered |
$ |
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Shipping & Handling |
$7 |
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TOTAL |
$ |
| Please indicate method of payment: |
| Check or Money Order made payable to: C.B.I. |
| Charge to: |
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