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AASP-IL/Collision Advice Webinar Registration Form
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AASP-IL/Collision Advice Webinar Registration Form
AASP-IL/Collision Advice Webinar Registration Form
optimaadmin
2023-09-07T20:53:12+00:00
AASP-IL/Collision Advice Webinar
Name
(Required)
First
Last
Shop Name
(Required)
Billing Address
(Required)
Street Address
Address Line 2
City
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Alaska
American Samoa
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Delaware
District of Columbia
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Guam
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Maryland
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Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
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State
ZIP Code
Email
(Required)
Phone
(Required)
How many people will be participating with your shop?
List additional attendees (up to 5)
Webinar Ticket Price
$0:
for current members
$25:
for non members
Payment Options
(Required)
Current AASP-IL Member (No Payment Required)
One time, Credit Card, 3.5% Fee
Check
ACH
For all credit card payments, the processing fee is included at checkout.
Membership Type
(Required)
Current AASP-IL Member | $0
Non AASP-IL Member | $25
Membership Type
(Required)
Current AASP-IL Member
Non-Member
Member Price
Price:
Non-Member Price
Price:
Bank Information
(Required)
Account Number
(Required)
Routing Number
(Required)
Accept
(Required)
I accept and authorize the ACH payments
By clicking [accept], you authorize AASP-IL to debit the bank account specified above for any amount owed for charges arising from your use of AASP-IL services and/or purchase of products from AASP-IL, pursuant to AASP-IL website and terms, until this authorization is revoked.
Important Steps
*ACH payment is initiated as you complete this form.
*AASP-IL will then set up a link to your account.
Check your bank account for a small deposit from AASP-IL.
*Verify this deposit and note the 6 digit code.
*Text the 6 digit code, along with your Business Name to Julie @ 630.561.3041.
*We will then confirm the payment.
This process may take a few days, depending on our mutual response times and the banks.
Complete online form & indicate check number & mailed date.
Please send to:
AASP -IL• 1005 W Huron St •Chicago IL •60642
Check Number
(Required)
Mail Date
(Required)
MM slash DD slash YYYY
Processing Fee
Price:
$0.00
Total
Credit Card
(Required)
Card Details
Cardholder Name
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