L Makeup Institute Enrollment Form, Las Vegas<

Which class are you signing up for:

Congratulations on your decision to enroll at L Makeup Institute. It's easy and secure! Simply fill in the fields below with your contact information and select a class from the drop down menu above.

First Name:
Middle:
Last Name:
Telephone:
Email:
Street:
City:
State:
Zip:
How did you hear about us?

To enroll in this class, please fill in all fields below. Full payment is required 14 days prior to the first day of instruction or you may finance the balance of your tuition by completing the next section.

CREDIT CARD INFORMATION

Credit Card #:
Expiration:	Month Year
Security Code:
CREDIT CARD BILLING ADDRESS
My billing addressis the same as above.
Billing Address:
Billing City:
Billing State:
Billing Zip:
Billing Telephone:
**Full refunds will be given in the event of a class cancellation by L Makeup Institute & Agency or if you apply for financing and are not approved.
Total due today:


Full payment is required 14 days prior to the first day of instruction or you may apply to finance the balance of your tuition by filling in the fields below. A representative from our financing department will contact you within 48 hours of your request.
ADDITIONAL STUDENT INFORMATION
How long at current address?
Do you rent/own/other?
Social Security #:
BANKING INFORMATION
Account Type:
Credit Card Type:
Bank Name:
INCOME AND EMPLOYMENT INFORMATION
Current Employer:
Job Title:
Monthly Gross Income:
Other Income:
Source:

APPLICANT AUTHORIZATION and CERTIFICATION
By submitting this application I certify that the information provided on this application is true and complete to the best of my knowledge and I give L Makeup Institute and Agency permission to verify the information I have provided by contacting employers, relatives, banking institutions and/or obtaining credit reports. I further authorize and instruct any person or consumer reporting agency to furnish L Makeup Institute and Agency any information that it may have or obtain in response to any inquiry regarding verification of information provided herein. I understand that L Makeup Institute and Agency reserves the right to deny me, or anyone else, credit for any reason.

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NOTICE OF FINANCIAL PRIVACY RIGHTS
L Makeup Institute and Agency collects the following non-public personal information about students applying to defer payment of tuition; information supplied on this application form, transaction history with L Makeup Institute and Agency and information provided by those parties you have authorized us to contact.

L Makeup Institute and Agency does not sell any personal information about its students or potential students but may disclose information as permitted by law and will disclose information as required by law. Otherwise, L Makeup Institute and Agency will only disclose or use a student’s or a potential student’s personal information to determine such student’s or potential student’s credit worthiness or to assist in collection efforts regarding a student’s account.

L Makeup Institute and Agency makes every reasonable effort to safe guard students’ and potential students’ personal information by restricting employee access to the information, educating employees regarding safeguarding personal information and by maintaining physical, electronic and procedural safeguards designed to prevent the unauthorized access of personal information.