Classic Training Academy Payment Form
Student's Name
*
First Name
Last Name
Student's Phone Number
*
Student's Email
*
example@example.com
Select Course
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Please Select
OSHA 10 $160
OSHA 30 $260
CNA 1
Medical Assistant
Phlebotomy Technician
Pharmacy Technician
Medication Aide
Home Care Provider Training class
Alignment $200
CPR Class $55 (card not included)
Homecare Training Policies
Janitorial
CLIA
Please fill out the next 3 boxes below if it's for home care Training Class
Agency Name Or Applicant Name
Franchise Company
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Yes
No
Class date desired
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Month
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Day
Year
Date
Address
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Street Address
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Amount $:
Amount $:
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USD
Course Description
Payment Methods
Credit Card
Apple Pay
After submitting the form, you will be redirected to Apple Pay to complete the payment.
Google Pay
After submitting the form, you will be redirected to Google Pay to complete the payment.
Cash App Pay
After submitting the form, you will be redirected to Cash App Pay to complete the payment.
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