Southern NevadaAcademy of Dental Assisting
School Application
I have selected the following payment plan for the dental assisting course:
____$2499.00 on or before the first day of class.
____$2599.00 payable in two installments of $1299.50 each. The first payment is due on or before the first day of class and the second payment is due on or before the fourth day of class.
Payment plans are available through Care Credit with terms as long as two years. We also accept Visa, Mastercard, and American Express
A $250.00 minimum down payment is required no later than one week prior to the start of each class with any of the above plans to guarantee your place in class. But remember we do fill up quickly and we take students on a first come first serve basis.
Please complete the following to reserve a place in our next class:
____payment in full $2499.00 ______ Check ______Money Order
$ _________ Down payment ______ Visa ______ Master Card _____ American Express
Credit card #________________________Exp. Date_____________
Name: ___________________________________________
Address: ____________________________
City: _______________________State:______Zip code:__________
Phone Number: ________________Cell Phone Number: __________________
Soc. Sec. #_______________________E-mail ___________________________
Birth date__________________________________________
Signature: ______________________________Date: _______