Student Enrollment Form Student Enrollment Agreement UrTruckConsult Career Training Please enable JavaScript in your browser to complete this form.SCHOOL INFORMATIONUrTruckConsult Freight Broker Training School 73 Dyke Thomas Rd, Texarkana, TX 75501 School Phone # 903-701-5788 STUDENT INFORMATIONName *FirstLastAddress *Address Line 1Address Line 2CityState / Province / RegionPostal CodeAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBolivia (Plurinational State of)Bonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo (Democratic Republic of the)Cook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Kingdom of)EthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIran (Islamic Republic of)IraqIreland (Republic of)Isle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea (Democratic People's Republic of)Korea (Republic of)KosovoKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia (Federated States of)Moldova (Republic of)MonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth Macedonia (Republic of)Northern Mariana IslandsNorwayOmanPakistanPalauPalestine (State of)PanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint Maarten (Dutch part)SlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyrian Arab RepublicTaiwan, Republic of ChinaTajikistanTanzania (United Republic of)ThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited Kingdom of Great Britain and Northern IrelandUnited States Minor Outlying IslandsUnited States of AmericaUruguayUzbekistanVanuatuVatican City StateVenezuela (Bolivarian Republic of)VietnamVirgin Islands (British)Virgin Islands (U.S.)Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland IslandsCountryPhone *Email *COURSE & COSTCourse Name: UrTruckConsult Freight Broker Training Course Length: 20 Classes Contact Hours 08:00 to 17:00 Date the training is to begin: Variable Tuition: $2,850.00 Other Expenses: (list separately) Books*: $ [IF APPLICABLE] Supplies*: $ Must have high speed internet connection For those who complete the training, the tuition includes 10 hours of ongoing consultation services through UrTruckConsult. The services provided there are to assist you in setting up your Freight Broker Business. All licensing, permits, insurance, bonding fees and additional costs are not included. * Fee is estimated and based on current cost and subject to change. TOTAL COST: $2,850.00METHOD OF PAYMENTNotice! I you choose to pay in full at the beginning of your training, You will receive a discount of $350.00 and only pay $2,500.00 for the Entire Course. Click here to View CoursesMethod of Payment *Money OrderCashier CheckPaypal (no account necessary)[If interest is charged or more than three payments are allowed, state the terms. If no interest is charged, so state] Payments will be allowed for this course. The following payment schedule are the only terms allowed. A payment of $150.00 paid prior to the start of each class. There are a total of 19 classes. There are no additional payments. The payment terms are each class paid in advance at the start of each course. The payment will be made online via the PayPal system. Checks may be mailed, however class will not be activated until check is cleared through the banking system. "Any holder of this consumer credit contract is subject to all claims and defenses which the debtor could assert against the seller of goods or services obtained pursuant hereto or with the proceeds hereof. Recovery hereunder by the debtor shall not exceed the amounts paid by the debtor hereunder."CANCELLATION POLICYNo refunds will be made to any student, at any time or for any reason. You are enrolling in an online training course that is accessible for a period of 365 days from your enrolment date. Once you have paid your tuition your access is granted and cannot be revoked. You are paying for digital services and media that cannot be returned.ACKNOWLEDGMENTS *I certify that I have read the Freight Broker Training Mission and Policy handout and agree to the terms and rules as stated in the Policy. ACKNOWLEDGMENTS 2 *I have received a copy of this enrollment agreement and agree to the terms and conditions.SIGNATURE OF STUDENTDate (copy) *Printed Name of Student *SIGNATURE OF AUTHORIZED SCHOOL OFFICERDate *Printed Name of Student (copy) *You must include a signed and dated copy of the Mission-Policy Statement with this application for admittance to UrTruckConsult Freight Broker Training Class. Click Here to Read Mission Policy.Mission Policy Agreement *I have read, understand and agree to the Policies presented in this notice.Submit8115571606