The Residential Collection Company Application

5423 Richenbacher Avenue, Alexandria, Virginia, 22304.

E-MAIL at "PDILLON43@AOL.COM"

			Courses Ordered	$290.00 $190.00 Each
Student Name:	__________________________________________		______	______
Student Address:	__________________________________________
	__________________________________________
	__________________________________________
Phone:	______________________
E-Mail:	______________________
Company name:	__________________________________________
Company address:	__________________________________________
	__________________________________________
Phone:	______________________
E-Mail:	______________________
Return Address:	_____Student _____Company
Make check or money order payable to:
The Residential Collection Company
Send check or money order to:
The Residential Collection Company
5423 Richenbacher Avenue
Alexandria, VA. 22304
After application is received, please allow two to three weeks for delivery. Sorry no C.O.D.'s accepted.
If more than one course is ordered at the same time, each course will have to be assigned to a student for test scoring purposes.
Student Name:	__________________________________________
Student Name:	__________________________________________
Student Name:	__________________________________________
Student Name:	__________________________________________
Student Name:	__________________________________________
Student Name:	__________________________________________
Student Name:	__________________________________________
Student Name:	__________________________________________
Student Name:	__________________________________________
Student Name:	__________________________________________
Student Name:	__________________________________________
Student Name:	__________________________________________
Student Name:	__________________________________________
Student Name:	__________________________________________
Student Name:	__________________________________________
Student Name:	__________________________________________
Student Name:	__________________________________________
Student Name:	__________________________________________
Student Name:	__________________________________________
Student Name:	__________________________________________
Student Name:	__________________________________________
Student Name:	__________________________________________
Student Name:	__________________________________________
Student Name:	__________________________________________
Student Name:	__________________________________________
Student Name:	__________________________________________
Student Name:	__________________________________________
Student Name:	__________________________________________
			______	$______
			Total of Courses Selected.	Total Dollar Amount of Courses.
Please Print this Application.

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