COURSE RESERVATION FORM

Course Title: ______Sage Payroll______________________________________ Date of course: 10/03/2011__________________ Please reserve __1____ place(s) on the above course, at a cost of __149 per delegate = TOTAL 149__________
Delegate Information
Delegates Name (Please complete in full and in block capitals) Date of Birth
(for advanced enrolment purposes)

Does the delegate have any special requirements If so, ? please give details. (Please refer to the City Business Terms and Conditions) YES / NO NO YES / NO YES / NO YES / NO

SUMITRA SHAH

25/12/1982

Please Note, certificates will be sent to the learner (above) and confirmation of the results will be sent to the E-mail address below Your Name: __MISS SUMITRA SHAH_______________________________________ _____________________________________ Company Name: _________________________________________ ________________________________________ Position in Company: Business Sector:

Address: ___38, THE RETREAT, SOUTHSEA,PORTSMOUTH ________________________________________________________________________________________________ ___________ _____________________________________________________________________________________________________________________ Postcode: __PO5 3DU______________________ ___________________________ Telephone: __07805062710_____________________________ Fax:

EMail:____sumitrasha@gmail.com___________________________________________________________________________________________ _________________

Payment Details I will be paying by Invoice (only if the course starts in over 2 weeks) / Cheque / Card / Cash (delete as appropriate) Cheque:
Please make payable to Southampton City College

Card:

We accept the following: Visa, MasterCard, Solo,and Maestro.

Name of Card Holder _Miss Sumitra C Shah___________________Signature of Card Holder __________________________ Please charge my Access/Visa Account No: 921 8196 8209 1534 with _____149_________ 4 Start date: _12/09___________ of card) ___987_______
. to pay

Expiry date: __11/12_________

Security Code (last 3 digits on back

Visa Electron payments can only be taken via swipe; therefore, card holders must brng this completed form to the College in advance and in person i

Invoice:
payments)

Please invoice my company at the above address.(It is essential to have an authorising signature for invoicing or Card Authorising Signature_______________________________ Date: _________________________________________

COURSE RESERVATION FORM

Name: ___________________________________________ Position: ______________________________________ Purchase Order No: __________________________________________

Receipt required: Yes / No

For office use only: Booking Log (sign): ________________

Promotional Code (if applicable):____________

Course Code: ___________________________ Confirmation sent (date): ___________________ Passed to Finance (date): __________________

CRMS Account/Student No: ________________________ Invoice No: ___________________________ Receipt No: ___________________

Additional Information
Confirmation of your course reservation will be forwarded,with all relevant details, on receipt of this form. (Whilst every effort will be made to run this course according to the published date(s), the College reserves the right to ca or vary the ncel date(s) should this become necessary due to circumstances beyo our control) nd How did you hear about the course?
(Please circle)

City College Website Local Paper (please state)

Search Engine (please state) Word of Mouth

Business Training Calendar Other (please state)

City Business may wish to contact you regarding future offers or events, if you do not wish to receive this information, please tick this box: Please ensure that all sections are fully completed, and return to: Course Bookings City Business Southampton City College FREEPOST Southampton SO14 1UH (Please note that no postage stamp is required)

Once you have confirmed your place on thi course, a cancellation fee willapply if you do not attend. All notification of cancellations / s replacements must be made in writing to the City Business. Please ensure you read the full copy of terms and conditions. Cancellation Charges 7 days or less 100% of total fee will be charged 8-14 days 75% of total fee will be charged 15-28 days 50% of total fee will be charged 29 days or more no fee chargeable * Please note that delegates with less than three years entry into the UK will need to contact us for fee information. If booking more than one course, please use separate booking forms photocopy as necessary

COURSE RESERVATION FORM

Employer Engagement, City College Southampton, St Mary Street, Southampton, SO14 1AR Tel: 023 80 577 426 Fax: 023 80 577 476 E-mail: info@resultsforyourbusiness.com Web: www.resultsforyourbusiness.com