VITOUSEK REAL ESTATE SCHOOL

Name:
_________________________________________________________
Address:
_________________________________________________________
City:State:Zip:
_________________________________________________________

Contact Phone: ( ________ ) ___________ - __________________

I want to register for: (Please mark appropriate course)

Honolulu - Classroom/Home Study Combination Program:  AM PM
    Salesperson ($450) 

Honolulu - Classroom Program:  AM PM
    Salesperson ($499) 

Exam Prep Kit (For person with out-of-state license).
    Salesperson ($125) Broker ($150)

Independent Study Course (Hard Copy) - Salesperson ($450)
    Broker ($649)

Independent Study Course (Online) - Salesperson ($450)  Broker ($799)
       (Please register and pay online using links provided on ISC page of website)

I want to pay by:
Personal Check Credit Card (Master Card or Visa only)
Amount paid:
$450 $499 $649 $140 Deposit
    Exam Prep Kit: $125 (Sales) $150 (Brokers)

   MasterCard or Visa: __________ - __________ - __________ - __________

   Expiration Date (mo/yr): _________ / _____________

Deposit Policy:
Your $140 deposit reserves a seat for you in class. In the event you need to cancel your reservation, notification must be received by 12:00 p.m. on the Friday prior to the first day of class. If notification is not received by this deadline, your deposit will not be refunded, nor can it be used for a future class.

How did you hear about us? _______________________________________

Please print out this page, fill out all the information above and mail with payment to:

    Vitousek Real Estate School
    PO Box 235846
    Honolulu, HI 96823