Cottonsoft Pty Ltd - Courses - Into Computing and Onto the Net

Please complete the details of the form below and click the submit button. Electronic submission of enrolment of this form is only available to course applicants from government institutions and businesses (please quote an order number and an authorisation contact phone number and name in the comments section at the bottom of the form - an invoice will be sent) or those who accept delivery of course materials on a COD (Cash on Delivery) basis.

Personal Details
Title	Name
Mrs Mr Miss Dr Ms
Email

Address

Suburb/Town	Post Code/ZIP

Country

Work Phone	Home Phone
Please include country and area codes.

Fax	Do you have access to a computer?
Include country and area codes.	Yes No

Reasons for taking this course

Payment Details
Course Fees $86.90 per participant payable on enrolment (includes delivery of course materials within Australia - other countries will involve an additional delivery fee)
Payment Type
Please invoice my organisation for the $86.90 enrolment fee (Please complete details on right).	Organisation Name

	Order Number

	Authorisation By

	Authorising Person's Contact Phone Number

Please deliver the course to the above address. I agree to pay the full course fee of $86.90 by COD (Cash on Delivery) through my local Post Office delivery service.
Please deliver the course to the above address. I agree to pay the full course fee of $86.90 by credit card (Please complete details on right).	Card Type
	Visa Mastercard Bankcard AMEX
	Card Number
	The 5th box here is for the Card Check Numbers. These are the last 3 numbers located on the back of VISA & Mastercards near the signature.
	Name On Card

	Expiry Date

Enrol

Overview - Purchase

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