I request a adjusterscampus.com business account authorization for online training courses. I understand that completion of this application will result in my company/organization receiving an authorization code that my employees can use to access training courses via a computer with modem/Internet access anytime anywhere.

After processing this application, adjusterscampus.com will issue my company an authorization code. I understand that it is my responsibility to inform current/prospective employees of this code and that I am responsible for payment of all certificates issued to trainees via this code. adjusterscampus.com will provide a report of all certifications and employee names prior to charging/billing your account for verification purposes.

Please type/print the following information. Allow 5 days for processing. Authorization codes will only be given to the contact person listed on this form and is subject to change.

First Name

Last Name

Email

Address

Zip :

City :

Phone

Company

Type of Business :

Sole Proprietorship

Corporation

Partnership

Federal Employer Identification No.
or
Local State Taxpayer No

Learning Portals Other Services Company