Arkansas Sales and Use Tax School

Beginner's Course Date Selected:                       

Advanced Course Date Selected:               

Seminar Tuition includes manual:

_________  $275.00 Single registrant Per Course

_________  $250.00 each for two or more Per Course

Name of Attendees (Please Print or Type)

1a.    Name: ______________________________

1b.    Title: _______________________________

1c.    Last Four Digits of Social Security #: _______

1d.    Email:  _____________________________

2a.    Name: ______________________________

2b.    Title: _______________________________

2c.    Last Four Digits of Social Security #: _______

2d.    Email:  _____________________________

3a.    Name: ______________________________

3b.    Title: _______________________________

3c.    Last Four Digits of Social Security #: _______

3d.    Email:  _____________________________

Approving Manager:

Name: ______________________________

Title: _______________________________

Email:  ______________________________

FIRM NAME                                                                                                               

ADDRESS                                                                                                             

CITY                                                                                                                       

STATE                                                                                                                    

ZIP CODE                                                                                                             

TELEPHONE     (        )                                     

FAX (      )                                       

Method of Payment:

�      Check enclosed payable to:  Arkansas Sales and Use Tax School 

�      Charge to credit card (Please 'X' which card)             VISA     ____ MasterCard

                                                                                              Authorized Signature

Credit Card Number                                                                                              

Expiration Date                                                                                                        

FAX:  Complete this form, fax entire panel including payment information to:   (501) 922-4327

MAIL:  Detach or Photocopy this panel and mail with payment information to:

*Arkansas State Board of Private Career Education requires by Arkansas Law.  This private information will not be shared with anyone or any institution.  Questions regarding the Arkansas State Board of Private Career Education regulations can be directed to the board at (501) 683-8000.

 TELEPHONE:   (501) 922-4327

GENERAL QUESTIONS:   (501) 922-4327

 Questions concerning these courses may be submitted to the Arkansas Sales and Use Tax School via internet:         b.pritchett@sbcglobal.net

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