ENROLLMENT AGREEMENT

First Name Sex:    Male    Female Middle Name     Last Name     Address Apt # City   State.   Zip:  Phone Other Phone Date of Birth Birthplace: Email

Please select one of the following payment plans: (check one)

	PLAN	DESCRIPTION	PRICE
	A	Paid in full	$395.00 (save $100)
	B	Monthly Plan:	$495.00
I have enclosed a down payment of   ($50.00 or more) and I will pay ($50.00 or more) per month
Minimum age for a student is 16 years or older You have up to 8 months to complete this program.

Payment Details
Visa		Master Card		American Express
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Card Number
Credit Card Expiration Date:	January February March April May June July August September October November December   2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
Billing Zipcode
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Benjamin Franklin High School - DiplomaFromHome.com
2715 Tigertail Avenue, Suite # 203, Coconut Grove, FLorida 33133
Phone: 1-800-264-8330
Email: info@diplomafromhome.com