Pre-payment for other persons

Ai-SecurityAcademy.com 3rd Party Payor form. Company managers can use this form when paying an employee’s course enrollment fees. When submitting payment for a student, Ai-SecurityAcademy.com will provide the beneficiary student with a coupon code to use during checkout when the student enrolls in a course and creates a student account.

Please identify the student for who you are providing enrollment fee payment and select the course(s) which you authorize the student to enroll.

PLEASE COMPLETE THE SECURE PAYMENT LINK BEFORE SUBMITTING YOUR ORDER FORM

Click the Secure Payment Link (a new window will open) and remit the amount quoted by Henry or Luis or to remit payment for your invoice as shown in the total above. Credit card or e-Check payments options are available for your convenience.

Please enable JavaScript in your browser to complete this form.

Purpose *

• Paying course enrollment fee for the student named below
• Paying course enrollment fee the named student having already taken our course
• Paying specific amount as directed .

Student Name *

First

Last

Student Email *

Student Phone Number

Last 6 digits of Student SS#

Multiple Items

• MMPI Assessment (Online) – $180.00
• Level II (Non-commissioned – 6 hr Online Classroom Only) – $49.00
• OC Spray – (3 hr Online Classroom Only) – $49.00
• Texas LTC (4 to 6 hr Online Classroom Only) – $49.00
• Level III (Commissioned – 30 hr Online Course Only) – $125.00
• Level III – Range and 10 to 15 hr Defensive Tactics Only (Subcontracted) – $100.00
• Level III (Renewal – 4 hr Online Course Only) – $49.00
• Level III Renewal – 2 hr Range Only (Subcontracted) – $50.00
• Individual CE – $149.00
• Company Owner CE – $149.00
• Investigator <15 CE – $149.00
• Investigator >15 CE – $149.00
• Entering Special Payment below – $0.00

6 SS# Total

Special Payment

Price: $1.00

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When directed by us to use the “Special Payment” selection, enter the full amount as the quantity. For example, if we direct you to pay $150, select 150 as the quantity on this item and then enter $150 as the total amount to be charged on the credit card submitted.

NOTE: The $1 amount listed for price will NOT change, but you should enter the amount specified by either as the quantity and the credit card submission form.

Stripe Credit Card *

Total

$0.00

Submit