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                                                                                                                        1315 Coraopolis Heights Road
                                                                                                                                           Suite 1001
                                                                                                                           Moon Township, PA 15108
                                                                                                                             United States of America

                                                    ENROLLMENT FORM
Three Ways To Enroll:
1. Register online at www.NextLevelPurchasing.com/registration.html (credit/debit card orders only)
2. Complete this form and fax to 1-412-294-1992 (credit/debit card orders, transfers, and purchase orders only)
3. Complete this form and email to info@nextlevelpurchasing.com (transfers and Western Union only)
4. Complete this form and mail to the address above

Company Name:_______________________________ Student Name:__________________________________
Student Phone Number:_________________________ Student Email Address:___________________________

Address Where Certificate Should Be Sent:                         Home               Work             (check one and write address below)

____________________________________________________________________________________________

Name of Person Who Referred You (optional):______________________ Offer Code (optional):______________

Check off all courses/programs in which you are enrolling:

          Course #         Title                                                                     # of              Cost (in US dollars)
                                                                                                     Lessons
               A           Mastering Purchasing Fundamentals                                              8                     $209.00
               B           Microsoft Excel For Purchasing Professionals                                   8                     $209.00
               C           Supply Management Contract Writing                                             8                     $209.00
               D           Microsoft Project For Purchasing Professionals                                 8                     $209.00
               E           14 Purchasing Best Practices                                                   8                     $209.00
               F           Savings Strategy Development                                                   8                     $209.00
               G           Powerful Negotiation For Successful Buying                                     8                     $209.00
               H           Expert Purchasing Management                                                   8                     $209.00
               I           Basics of Smart International Procurement                                      8                     $209.00
               J           Executing A Global Sourcing Strategy                                           8                     $209.00
               K           Negotiation No-No's                                                            1                      $14.99
               L           SPSM Certification Program (includes courses A-F)                             48                    $1,149.00
               M           SPSM Certification & Enhanced Results Program                                 48                    $1,749.00
                           (includes courses A-F)
               N           Fee if sending your payment by Western Union                                    0                     $25.00


Total Amount For All Checked Lines: $_______________

Payment Method (check one):
 Check/International Money Order/Bank Draft/Cheque (Enclose check/money order/bank draft/cheque made
   payable to Next Level Purchasing, Inc.)
 Purchase Order (Attach purchase order, terms are net 15)
 Credit/debit card (Complete and submit page 2 also)
 Wire Transfer/TT
 Western Union (Payment must include fee for Line N. Include Money Transfer Control Number in email.)

I hereby submit this application subject to the Registration Policy found at http://www.NextLevelPurchasing.com/purchasing-policy.html.


Signature:___________________________________ Date:___________
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                                                                                     1315 Coraopolis Heights Road
                                                                                                        Suite 1001
                                                                                        Moon Township, PA 15108
                                                                                          United States of America




                                  CREDIT CARD INFORMATION

Type of card (circle one): Visa          MasterCard            American Express      Discover
Name on card:___________________________________________
Card #:_________________________________________________
Expiration date (mm/yy): __ __ / __ __

Card Security Code (3 or 4 digits on back of card): _____________


Address Where Your Credit Card Statement Is Sent (you may leave blank if same as address on page 1)

______________________________________________________

______________________________________________________

______________________________________________________

______________________________________________________



Signature:___________________________________ Date:___________




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