|
|
Online Enrollment Form for:
Professional Service Advisor Development Program™ |
 |
|
|
|
|
|
|
|
Company/Owner Information (required information denoted by *)
|
| *First Name |
|
| *Last Name |
|
| *Job Position or Title |
|
| *Business Contact Email |
|
| *Company Type |
|
| *Company Name |
|
| Department |
|
BLIG Group
Member # |
|
| NAPA AutoCare # |
|
| *Business Address |
|
| Address Line 2 |
|
| *City |
|
| *State |
|
| *Zip |
|
| Country |
|
| *Contact Phone |
–
–
|
| *Main Shop Phone |
–
–
|
| *Is call blocking enabled? |
(main shop number) |
| *Fax |
–
–
|
*Registration Form
Completed by |
|
|
Attendee Information (required information denoted by *)
|
| *Attendee First Name/Nickname |
|
| *Attendee Last Name |
|
| *Attendee Job Position or Title |
|
*Attendee Contact Email
|
Attendee's email address must be different than
the Business/Owner's email address listed above.
Please ensure this email address can accept 2MB minimum file downloads. |
|
|
|
|
|
Vehicle Types Serviced (required information denoted by *)
|
| *Types of vehicles serviced |
|
| Other/Specialty (Please specify) |
|
|
|
|
Preferred Session Start Time
|
Please select your preferred session start time (please note that start times are Pacific Standard Time). Professional Service Advisor Development Program™ Training is presented once per month, 2 hours per day over 2 days. There are 4 time choices to choose from: 6:00 am; 8:30 am; 10:30 am and 11:00 am. You will be assigned to a PSADP Class based on your time selection.
Note: Although we will do our best to assign you with your preferred time, there may be circumstances in which we will be unable to fulfill your first choice. We make no guarantee on preferred start times. Please indicate below your first and second start time choices. Do not duplicate your choices, please indicate two different start times. |
| Start Time Choice 1
|
| Start Time Choice 2
|
| Start Month
|
Please fill out the required information below.
|
|
|
Payment Information (required information denoted by *)
|
| You may pay for your Professional Service Advisor Development Program™ enrollment using your Credit Card only. Please fill out the information below: |
| *Credit Card Type |
|
| *Card Number |
|
| *3/4 Digit Code |
|
| *Exp Date (MM/YY) |
|
*Name, exactly as it
appears on the Card |
|
| Billing Address |
|
| Address Line 2 |
|
| City |
|
| State |
|
| Zip |
|
*Enter YES into this box to hereby serve as your electronic signature of understanding and acceptance to the terms and conditions as outlined above.
STOP! Before you click on the "submit" button, review the form to ensure that you correctly and completely filled out all the required fields. Also, check to make sure that you have selected the CORRECT start time and month from the menu above.
|
|
|
| |
|
