WRECKMASTER'S

COMPANY PORTAL

Cash Or Check Payment Form

Class Location, Level and Date(Required)

Instructor Name(Required)

Payment Information

Payment Method(Required)

Check Payment

Cash Payment

Other

If Other selected please indicated the form of payment.

Check Number

Check Amount

Upload a Picture of the check

Max. file size: 512 MB.

Please upload a picture of the check.

Order Contact Information

Name of Contact Order should be under(Required)

First Last

Please enter the name of the contact the order should be under. This is the contact that will receive a copy of the order receipt.

Order Contacts Email(Required)

This email can not be the same as any of the operators that attended the class. Each student and order contact need to use unique emails address.

Company Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Company Phone

Student Information

Student Name

First Last

Student Email

Email cannot be duplicated

Tuition Price

Student Name

First Last

Student Email

Email cannot be duplicated

Tuition Price

Student Name

First Last

Student Email

Email cannot be duplicated

Tuition Price

Student Name

First Last

Student Email

Email cannot be duplicated

Tuition Price

Student Name

First Last

Student Email

Email cannot be duplicated

Tuition Price

Student Name

First Last

Student Email

Email cannot be duplicated

Tuition Price

Student Name

First Last

Student Email

Email cannot be duplicated

Tuition Price

Student Name

First Last

Student Email

Email cannot be duplicated

Tuition Price

Student Name

First Last

Student Email

Email cannot be duplicated

Tuition Price

Student Name

First Last

Student Email

Email cannot be duplicated

Tuition Price

Total

Notes

Please make all checks payable to WreckMaster. Unfortunately WreckMaster multi student discount can not be applied to Check or cash payments. If the student or host wishes to have these discounts applied they will have to prepay and register there students before the class using a credit card.