Email:*

Salon Name: (if applicable)

Street Address:*

City:*

Province / State:*

Country:*

Postal Code / Zip Code:*

Phone #:*

Social Insurance # (Canada Only)

To be eligible for an official Canadian Tax Credit,
the federal government requires your social insurance
number be included on the official receipt.

2. Second Applicant Information

Name:*

Email:*

Salon Name: (if applicable)

Street Address:*

City:*

Province / State:*

Country:*

Postal Code / Zip Code:*

Phone #:*

Date of Birth:*

Employee Social Insurance # (Canada Only)

To be eligible for an official Canadian Tax Credit,
the federal government requires your social insurance
number be included on the official receipt.

Click on down arrow to select: _$1895 -Diploma - Hands On _$1495 - Diploma - Hands Off

(plus applicable taxes in Canada)

Payment Info:

Credit Card

Card Type:

Please Select: Visa Mastercard Discover American Express

Card Number:

Card Expiry Date:

mm/yy

Card Verification Code (CVC)
(The CVC Number on your credit card is a 3 digit number on VISA, MasterCard and Discover branded credit cards. On your American Express branded credit card it is a 4 digit numeric code.)

CVC #

Exact Name on Card: