A Center for Continuing Education Order Form

A Center for Continuing Education
(770) 702-7917
(800) 344-1921
Fax: (770) 702-7914

A Center For Continuing Education Order Form

Please check the information below for accuracy. When you are sure it is correct click the Purchase Button. Please add 'confirmation@acceducation.com' to your address book to insure that you receive your confirmation email and other correspondence.

Course/Class Name	Qty	Cost	Total
Total	$0.00


ALL Fields are REQUIRED.
First Name of Student:	(This is the First Name of the Student who is taking the course)
Last Name of Student:	(This is the Last Name of the Student who is taking the course)
Email of Student:	(This is the email address of the student who is taking the course.)
Credit Card Type:	Visa MasterCard American Express Discover Card
Credit Card #:	(Do NOT include any dashes, slashes or spaces)
Expiration Date:	(MMYY) Security/CCV Code:


Billing Address
Street:
City:
State:	Zip:
Work Phone:
Home Phone:
Cell Phone:

Registration Information

Social Security No:

of Student taking the course
(Enter ONLY the last 4 digits of your Social Security.)

Month of Birth:

How did you hear about us?

Our online courses are compatible all devices, this includes smart phones and tablets.

All the information we collect is used only for processing and tracking your continuing education needs. We do not share or sell your personal information to other organizations. For specific details on the information we collect and how it is used see the link to our Privacy Policy below.

Credit Card Processing

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A Center for Continuing Education
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2550 Sandy Plains Road, Suite 225-138 ♦ Marietta, Georgia 30066
(770) 702-7917 ♦ (800) 344-1921 ♦ Fax: (770) 702-7914