Referral Form

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" height=380 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <B>Referral Form</B><FONT SIZE="6" COLOR="#000000" FACE="Arial" ><B>  </B></FONT></div> <div>  <form action="http://csbmail.globalscape.com/cgi-bin/csbmail/csbmail.pl" method="POST" enctype="application/x-www-form-urlencoded"><input type="hidden" name="tlx_SortOrder" value="Company,firstName,lastName,email,address1,address2,city,state,zip,phone,fax,chkboxname,chkboxname2"><input type="hidden" name="tlx_FormIndex" value="2"><input type="hidden" name="tlx_OKMessage" value="Thank you for your referral."><input type="hidden" name="tlx_SendMode" value="1"><input type="hidden" name="tlx_Subject" value="A Referral Form was sent"><input type="hidden" name="tlx_EmailTo" value="CaslerSchool@aol.com"> <table cellpadding="5" cellspacing="1" border="0" align="center"> <tr> <td align="left">Name of Company (type in or attach business card) wishes to refer the following prospective student: <br> <textarea name="Company" rows="8" cols="50"></textarea> </td> </tr> <tr> <td align="left">First Name of prospective student: <br> <input type="text" name="firstName" size="30" maxlength="100"> </td> </tr> <tr> <td align="left">Last Name: <br> <input type="text" name="lastName" size="30" maxlength="100"> </td> </tr> <tr> <td align="left">Email: <br> <input type="text" name="email" size="30" maxlength="100"> </td> </tr> <tr> <td align="left">Address Line 1: <br> <input type="text" name="address1" size="30" maxlength="100"> </td> </tr> <tr> <td align="left">Address Line 2: <br> <input type="text" name="address2" size="30" maxlength="100"> </td> </tr> <tr> <td align="left">City: <br> <input type="text" name="city" size="30" maxlength="100"> </td> </tr> <tr> <td align="left">State: <br> <input type="text" name="state" size="30" maxlength="100"> </td> </tr> <tr> <td align="left">Zip: <br> <input type="text" name="zip" size="10" maxlength="10"> </td> </tr> <tr> <td align="left">Phone Number: <br> <input type="text" name="phone" size="14" maxlength="14"> </td> </tr> <tr> <td align="left">Fax Number: <br> <input type="text" name="fax" size="14" maxlength="14"> </td> </tr> <tr> <td align="left">This student is interested in: <br> <div> <input type="checkbox" name="chkboxname" value="90 hour SALESPERSON prelicensing course"> 90 hour SALESPERSON prelicensing course<br></input><input type="checkbox" name="chkboxname2" value="90 hour BROKER prelicensing course"> 90 hour BROKER prelicensing course<br></input> </div> </td> </tr> <tr> <td align="right"> <input type="reset"> <input type="submit" value="Send" name="tlx_send"> </td> </tr> </table> </form>  </div> <bR> <div> Whether or not you submit this form online, you MUST send this form with the Student; Student MUST present this form at time of registration.</div> </td> <td valign="top" rowspan="2" width=249 style=" border-left: 1px solid #990000;" BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <IMG BORDER="0" SRC="1x1.gif" HEIGHT="17" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" WIDTH="17">     <FONT SIZE="4" COLOR="#0000BF" FACE="Arial" > <A HREF="index.htm" TARGET="_top" TITLE="Casler School of Real Estate">HOME </A></FONT>     <IMG BORDER="0" SRC="1x1.gif" HEIGHT="17" ALIGN="BOTTOM" HSPACE="0" VSPACE="0" WIDTH="17"></div> <bR> <div> <B>CLASSROOM LINKS</B></div> <bR> <div> <A HREF="classroom_enrollment_form.htm" TARGET="_top" TITLE="Classroom Inquiry Form">Enrollment Inquiry</A></div> <bR> <div> <A HREF="calendarcourses.htm" TARGET="_top" TITLE="Courses">Description of Courses</A></div> <bR> <div> <A HREF="id61.htm" TARGET="_top" TITLE="How Do I Get Started ?">How Do I Get Started?</A></div> <bR> <div> <A HREF="prelicensing_requirements.htm" TARGET="_top" TITLE="Prelicensing Requirements">Prelicensing Requirements</A></div> <bR> <div> <A HREF="id2.htm" TARGET="_top" TITLE="Renewal Requirements Brokers/Agents">Renewal Requirements</A></div> <bR> <div> <A HREF="prices_for_courses.htm" TARGET="_top" TITLE="Price List and Special Packages for cour">$</A><FONT SIZE="4" COLOR="#0000FF" FACE="Arial" ><A HREF="prices_for_courses.htm" TARGET="_top" TITLE="Price List and Special Packages for cour"> Price List for Courses </A></FONT><A HREF="prices_for_courses.htm" TARGET="_top" TITLE="Price List and Special Packages for cour">$</A><FONT SIZE="4" COLOR="#0000FF" FACE="Arial" ><A HREF="prices_for_courses.htm" TARGET="_top" TITLE="Price List and Special Packages for cour"> </A></FONT></div> <bR> <div> <A HREF="id48.htm" TARGET="_top" TITLE="School Policy Classroom Instruction">Classroom School Policy</A></div> <bR> <div> <A HREF="id37.htm" TARGET="_top" TITLE="About the Casler School of Real Estate">About the School</A></div> <bR> <div> <A HREF="faqs___classroom.htm" TARGET="_top" TITLE="FAQs Classroom">FAQ's</A></div> <bR> <div> <A HREF="id46.htm" TARGET="_top" TITLE="Online Courses for Brokers/Agents">go to: ONLINE SCHOOL</A></div> <bR> <div> APPROVED</div> <div> BY</div> <div> <A HREF="http://159.87.254.2/publicdatabase/DetailSchool.aspx?Id=102" TARGET="_top" TITLE="http://159.87.254.2/publicdatabase/Detai"><IMG SRC="19f5a5a0.png" border=0 width="90" height="90" ALIGN="BOTTOM" HSPACE="0" VSPACE="0"></A></div> <div> (click here to verify)</div> <bR> </td> </tr><tr> <td valign="top" height=99 style=" border-top: 1px solid #990000;" BGCOLOR="#FFFFFF" TEXT="#080000" bgproperties="fixed" background="01200640egerdp.png"> <bR> <bR> <div> Phone:<B> 623-935-9949</B></div> <bR> <bR> </td> </tr></table></body>