Mail To:

Andy Beverly's Florida Insurance School
P.O. Box 3522
Tallahassee, Florida 32315-3522
(850) 878-5091, Fax: (850) 878-0235
1-800-634-5813

Pre-registration required prior to first day of class.

Name__________________________________

Address________________________________

City____________________ Zip_____________

Return to:

Florida Insurance School
P.O. Box 3522
Tallahassee FL 32315

____Check Enclosed ( Company Checks Only )

Charge My: ____Visa____ MasterCard ____ Discover

Acct. #_________________________________

Amt.$______________ Exp. Date___________

Credit Card ID Code: _______ Find Location?

Signature______________________________

Print Name_____________________________

Refunds will be issued as credit for future classes only.

Office Use Only

Received__________________________________

Amt. $_______________Per. ________Co. ______

Company__________________________________

Daytime Phone______________________________

Fax #_______________________________

SS #________________________________

Email Address___________________________________________

Check One

License Exam Prep  ____ In-Class  ____ Webinar

1-Day Life, Health/VA Exam Prep* ____ In-Class  ____ Webinar

Life, Health/VA Qualifications Course ____

52 Hr Personal Lines ____ In-Class ____ Online

200 Hr Property & Casualty Course  ____ In Class __ Online

40-hour P&C for CSR's  ____

Class #_________________

City________________________________

Textbooks must be ordered 5 working days in advance of class date.

* Life/Health Textbook needed for Life/Health & VA Qual. Course:
  In class - $40.00    _____
  Mailed - $45.00     _____

Email: sales@floridainsuranceschool.com