Online PCT Enrollment & Installmental Payment Form

Online PCT Enrollment & Installmental Payment Form

You are about to enroll and make 3 installmental payments of $442.56 for the online Patient Care Technician class. The only remaining payment will be the Certification Exam fee of $150 which is payable to American Education Certification. It is to be paid towards the completion of your program. Our task is help you succeed.
The payment you are making today*
prevnext( X )
PCT Enrollment & Installmental Payment($442.56 for each two weeks)

Total $0.00
Your Name*

PrefixFirst NameMiddle NameLast Name
Your E-mail*

Confirmation Email
Cell Phone*

Area CodePhone Number
Phone Number 2

Area CodePhone Number
Address*

Street Address

Street Address Line 2

CityState

Zip Code
Should be Empty: