ezACADEMIC College Request Form

First Name:

Last Name:

E-mail:

Phone:

Address line 1:

Address line 2:

City:

State:

Zip:

Please enter up to 3 schools you would like information from, also select the State the school is located in. (If applicable)

1st School:

State:

2nd School:

State:

3rd School:

State:

Information will be sent via email. You may have it mailed to you for an additional processing fee.

*(please select one)

Inquires Via Email$100.00

Inquires Via Mail$110.00

Total $0.00

*ezACADEMIC uses PayPal to process credit card transactions, but a PayPal account is not required. If you do not wish to log in to PayPal just click continue and enter your credit card information after you have submitted your request.