Payment Agreement/Deposit Form

Payment Agreement/Deposit Form (CANADA)

Use this form for the initial deposit towards a class or package of classes. Additional payments are made on the Make A Payment form.
Name*

First NameLast Name
Preferred Name on Badge*
Address*

Street Address

Street Address Line 2

CityProvince

Postal Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Date of Birth:

MonthDayYear
Date
Gender*
Company/Organization
Please enter the name of the company you are with
Title/Position
Please tell us what your current title is
Payment Information
Class Attending:*
Please select an option
Package:
Please select an option
Deposit*

prevnext( X )
CADDescription
10th of each month25th of each month
Date of first installment:*

MonthDayYear
Date
NOTES
Include notes on this payment
Payment Plan Tuition Policy
PLEASE READ THIS SECTION CAREFULLY, and make sure you understand the payment schedule. You are considered registered when you make your initial payment (deposit). The first payment will be charged to your credit card today. All subsequent installments will be charged once a month starting on the date you specified above. All tuition payments are non-refundable. If you are using a debit card, you understand that this payment will be deducted from your account on the date you have designated.

Your specific seat can only be confirmed once you have paid the balance in full. You may pay off your remaining balance at anytime.

Tuition for all Convergence Seminars classes is non-refundable. Tuition funds must be utilized within twelve (12) months of the date of registration or they may be forfeited. If a participant chooses to change seminar dates within fourteen (14) days prior to the start of their seminar, they may be subject to a $100 processing fee.

The personal information you provide is solely intended to identify, contact and communicate with you directly via phone, email, and SMS. Convergence Seminars does not share or sell your information to a third party.
I agree to terms & conditions above.*

Clear

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

Should be Empty:

Payment Agreement/Deposit Form (CANADA)

Payment Information

Payment Plan Tuition Policy