CICorporation.com
Computer-Instructors.com
Request for Consulting or Instruction

Please fill out the following information and press the Register button below.
Call 800-DATA1OK with any questions or to discuss your needs and best payment options.

Your name: *
Organization:
Billing
Address:
City: State: Zip:
Phone:  * Fax:
eMail: *
Country: if not USA
Training Course
or
Description
of your
consulting
needs
Quantity:  
Hours/Days of consulting, or Number of Students to be trained
Location: Where would you the training or consulting to take place?
Client Site (Above address or: )
CICorp Classroom  Lab:
Via LogMeIn or  GoToMyPC - remote access (or PC-Anywhere)
Videophone - teleconference
Other

Time Frame:  
How soon would you like to proceed? (Next week, Next month, etc.)

Fees:

 MD,DC,VA,NY,CA, IA
Price Quote:
Preferred
Payment
Method:		  *

Name on the Card:

Credit Card Number:

Expiration Date:     Credit Card Verification Number:

Credit / Debit Cards: or

To avoid bookkeeping costs, and offer our clients more competitive rates, we do not offer services on credit.   By the day of the consulting or training, we request that a check or credit card be received.  There are no refunds and all sales are final.  Thank you.

Purchase Order: if applicable


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For classes, please list below the names of the course participants for their Student Certificates.