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FINANCIAL SERVICES BOOKING FORM Michael Rockson

FELIX AJAYI
For UK students

PERSONAL DETAILS AUTHORISATION TO INVOICE EMPLOYER

Title Date of Birth D D /MM / Y Y Y Y Company name

First name Company billing address/DX

Last name

Correspondence and delivery address/DX

Town/City Postcode

Authorising manager

Job title Daytime tel.

Town/City Postcode
PO Number
Email
VAT registration no.
Daytime tel.
Authorising signature*
Signature*
Accounts Payable tel.

Accounts Payable email

Employer to be notified of exam results and absences

Please tick as applicable below:
Self-funded Employer funded
Do you have any special needs/disability that may affect you in the event of a building evacuation whilst you are on BPP premises? Yes No
(If yes, please arrive for the start of the first day of your course 15 minutes early to allow for the local site Health & Safety Officer to complete the necessary evacuation procedure and assessments with you.)

A charge of 5.75 for the UK postage of course materials will be charged if your course, excluding face-to-face, includes materials in the package price.

COURSE DETAILS
Qualification Module/Unit name/number Study option Course location
(e.g. IAD, IMC, IOC, CISI Certs) (e.g. Unit 2/ Securities) (e.g. Full time, online, evening) (e.g. London, Edinburgh) Start date Price ()*

* If you are booking a package containing two or more course elements (for example, Full IMC consisting of Unit 1 and Unit 2 courses) please Postage:
enter your options for each component in the first 5 columns, but enter only the combined package price in the final column (in the first row)
Total:
Postage prices
UK 7.20
5.75
Europe/Rest of the World call +44 (0)20 8746 4178 for a postage quote
varies
PAYMENT (if not funded by employer) Save these card details for next time
If you would like to register these card details with us to facilitate future orders,
BY CHEQUE Please enclose cheque made payable to BPP Professional Education please tick here. Your card details will be held securely by BPP and/or our third
party payment service providers and, unless you tell us otherwise, we will use
BY CARD VISA MasterCard this card for payments in connection with this and any future BPP order.

Card holders name Grand total

Card holders address

Town/City Postcode
SEND TO
Card holders signature*
BPP Professional Education
Tel: +44 (0)20 8746 4178
FELIXAJAYI@BPP.COM
Date D D /M M /Y Y Y Y Email: financialservices@bpp.com
Fax: +44 (0)20 8746 4160
Card number
Aldine House, Aldine Place, 142-144 Uxbridge Road London, W12 8AA

Security code (last three digits on back of card)

Valid from M M /Y Y Expires M M /Y Y *Note: By signing this form you are agreeing to our Terms & Conditions as stated on our
website. To read the full Terms and Conditions go to bpp.com/terms
03 Apr 12