Pay As you Learn

VUE Testing Centre - Manchester

InCert - Pay As You Learn Postal Application Form - 2004 Packages
Title
First Name
Last Name
Address 1
Address 2
Town/City
Post Code
Telephone
e-mail address
Select Package Option using Pay as you Learn
Course	Select	Deposit	Payments
All-In-1		£1850	5 monthly payments at £500
MCSE 2003		£1499	5 monthly payments at £400
MCSA 2003		£850	5 monthly payments at £250
Network Administration		£725	5 monthly payments at £200
		£	5 monthly payments at £
Card Type
Card Number
Valid From Date (mm/yy)
Valid To Date (mm/yy)
Name as written on card
I authorise InCert to debit my account with the appropriate deposit immediately on receipt of this application and the corresponding five monthly payments commencing one month after this application is received. I will inform InCert immediately in writing if the card becomes lost or stolen.
Signature			Date
I understand that by submitting this request I am giving my consent for my personal data to be processed and used by InCert to contact me or send me any information that InCert believe may be of interest to me regarding the activities of InCert. The data obtained will not be passed to any third party except for legal reasons. Read the InCert Data Protection Statement. For any queries regarding the data inputted here contact data@incert.co.uk.
When complete, please post to: InCert (address at top of page)